reference manual for the artbrace 2018 - home page …demauroy.eu/pdf/art reference manual.pdf · 2...

Reference Manual

for the ARTbrace

2018SECOND EDITION

Jean C de Mauroy

P u bl i s h e d by t h e a u t h o rLYO N F R A N C E

iii

The information in this book is Open Access and could be shared with everyone if the information is freely given and the source

acknowledged No part of this book may be reproduced for profit

Copyright copy 2017 by Author Name

All rights reserved No part of this publication may be reproduced distributed or transmitted in any form or by any means including photocopying recording or other electronic or mechanical meth-ods without the prior written permission of the publisher except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law For permis-sion requests write to the publisher addressed ldquoAttention Permis-sions Coordinatorrdquo at the address below

Jean Claude de MauroyClinique du Parc155 Boulevard Stalingrad 69006 Lyon Francewwwdemauroyeu

Book Layout copy2015 BookDesignTemplatescom

Ordering InformationQuantity sales Special discounts are available on quantity purchases by corporations associations and others For details contact the ldquoSpecial Sales Departmentrdquo at the address above

Reference Manual for the ARTbrace Jean C De Mauroy mdash2nd ed 2017

Contents

History of ARTbrace 2

The interdisciplinary team approach 7

New concepts 11

Principles of ARTbrace 21

Brace prescription 32

Regional Shape Capture 36

Brace construction 41

Management of the patient with ARTBrace 51

Instructions for wearing the ARTbrace 55

Results amp discussion 59

Conclusion 65

Acknowledgments

I would like to express my gratitude to the late Cyril Lecantedagger

whose expertise understanding and patience added considerably

to my medical experience Cyril will not see the end of the ART-

brace project but every time a brace is fitted a small part of him

lives again This book is dedicated to him

A very special thanks goes out to Steacutephane Lecante who contin-

ued the work of his brother Cyril at the head of The Lecante- Pro-

teor Group He organised the first training sessions that gave birth to

this book I would like to also thank the other members of the team

and especially Sophie Pourret Freacutedeacuteric Didier Jonathan Alith and

the numerous others who worked on this project who unfortunately

cannot all be named here I must also acknowledge Pascal Genevois

who has been able with his whole team to finalise the new sensor

ldquoOrten full bodyrdquo specifically adapted to the ARTbrace

Thanks also goes out to my secretary Marina Catherin who has

the difficult task of organising appointments for patients and sup-

port them administratively in this ldquoobstacle racerdquo that is currently

the French Medical World Appreciation also goes out to the Radiol-

ogy Department at the Clinique du Parc - Lyon Park Clinic which

for many years has been at the forefront of technology with the EOS

system

The regional shape capture was born in 2013 during the SOSORT

meeting that I had the honour to chair The brace is the fruit of 10

years of research within the SOSORT and I am very proud that the

acronym ARTbrace was created by my friend Stefano Negrini

I would also like to thank my family for the support they gave me

through my entire life and in particular I must acknowledge my wife

Alice Without her love encouragement and patience I would not

have finished this book Furthermore my daughter Agnes who from

London corrects my English

In conclusion I recognise that this research would not have been

possible whithout the patients who sometimes come from so far and

who do their utmost to follow the insructions and protocols A spe-

cial thanks to Christine Chenot President of the french ldquoScoliose et

Partagerdquo Association who agreed to assess the psychological feeling

of this brace

Dr Jean Claude de Mauroy

Prolegomenon

There has been several major chapters in the conservative

treatment of scoliosis The most recent 70 years ago is the use of

plastic materials to replace leather One of the latest is the creation of

highly asymmetric braces by Jacques Checircneau 40 years ago (in-brace

reduction 30-40) Since then progress was more likely thanks to

the use of CAD CAM systems for the realisation of braces rather

than on the conception of the braces themselves Until recently only

very high rigidity braces were able to treat scoliosis of more than 40deg

The ARTbrace (in-brace reduction 69-73 ) combines high rigidity

Lyon braces and the Checircneau asymmetry which is obtained using a

regional shape capture and software with the superposition of three

forms determined by the patient itself according to its reducibility

After a period which can be referred to as lsquohighly surgicalrsquo the in-

terest to conservative treatments whose effectiveness has been sci-

entifically proven by BrAIST study is noted again The high rigidity

PMMA Lyon brace (in-brace reduction 40-50) has demonstrated

its effectiveness for scoliosis including adolescents and scoliosis over

40deg The new Lyon ARTbrace takes much of this legacy even if it

uses the most modern techniques and new concepts In fact the new

ARTbrace concentrates a maximum of technological innovations ex-

plaining a double in-brace correction than polyethylene ones

The primary purpose of this book is to provide all users of the

Very High Rigidity a Manual allowing them to use the high rigidity

and deal with the greater part of situations It is the fruit of three

years of specific experience It is destined primarily for all those

who attended the ldquoTraining Courserdquo in Lyon

The book is published in pdf or epub format For practical rea-

sons some of the multimedia documents figures videos and bib-

liographical references require an internet connection to be used

Some regular updates will be published according to feedback re-

ceived during training sessions

Remember the learning pyramid Reading + Audiovisual = 20

of learning

2 bull J E A N C D E M A U R O Y C O N T E N T R E F E R E N C E M A N U A L F O R T H E A R T B R A C E bull 3

c h a p t e r 1

History of ARTbrace

Lyon orthopedics began in 1741 with Nicolas Andry born in

Lyon and who published under the neologism ldquoOrthopae-

diardquo a book summarizing the different methods to prevent

and correct deformations in children Nicolas Andry analyzes the

malformations and understands the biomechanical principles re-

lated to the skeleton He is a keen supporter of movement therapy

that is to say physiotherapy The frontispiece of his book repre-

sents the torso tree which has become the symbol of many ortho-

pedic societies around the world

The orthopedic tradition for vertebral deformities was devel-

oped by Charles Gabriel Pravaz He was not only the inventor of the

syringe but he also created in Lyon a great Orthopaedic Institute to

treat scoliosis 200 years ago He published 2 books interesting for

us ldquoNew method of treating deviations of the spineldquoand ldquoGymnas-

tics applied to treatment of some constitutional diseasesldquo The Lyon

method also deals with physiotherapy exercises (PSSE) At that

time the present exercises characterising the Schroth were already

practiced

Another Lyon physician Claude Bernard is important to mention

He is the creator of Experimental Medicine as opposed to Empirical

and Observational medicine He wrote in 1865 ldquoScience is a perma-

nent exchange between theory and experimental facts And For a

man of science there is no separate science of Medicine or Physiol-

ogy there is only a science of liferdquo

Plaster cast and Plastic deformation

The first plaster casts were made in the early twentieth century

by Sayre and Abbott Calot at Berck resumes the principles of Sayrersquos

correction The cast is made in upright position the elongation ldquopullrdquo

effect is priority Subsequently Cotrel developed a Frame to facili-

tate Elongation Derotation and Flexion or bending (EDF) which is

used in the Lyon treatment The objective of the plaster is to obtain

a plastic deformation with elongation of the viscoelastic structures

of the concavity


Old Lyon Brace amp new ARTbrace

The Lyon Bracing Management with adjustable underarm brace

has evolved since 1947 as a cooperative effort between Pierre Stag-

nara MD and Bouillat amp Terrier CPO

The Lyon management protocol requires at first a plastic defor-

mation with a plaster cast for one to four months after which the

brace is shape captureed and fitted The brace is a high rigidity ad-

justable under arm design and does not have a superstructure

Very early braces were made from a combination of steel and

leather Following World War II Reacutegis Lecante CPO discovered a

Messerschmitt cockpit near his country house Made of a very du-

rable plastic it could be easily machined tapped and screwed The

use of PMM (polymetacrylate of methyl) or Plexidurtrade was born

revolutionising modern brace materials and design

The Lyon Brace created in 1947 by Pierre Stagnara is designed

to be

bull Adjustable It is easily modified accommodating up to 7 cm

of growth and 7 kg of weight while also being more cost effective

requiring fewer and less frequent changes

bull Active The rigidity of the Polymetacrylate or Ploycarbonate

structure stimulates the child to initiate an active axial auto correc-

tion which decreases superficial pressures

bull Decompressive As a consequence of the ldquoAdjustablerdquo fea-

ture the effect of extension between the two pelvic and scapular

girdles also decreases the pressure on the intervertebral discs and

promotes more effective pushes

bull Symmetrical In addition to being more aesthetically pleas-

ing the brace was much easier to build The new Lyon ARTbrace is

Asymmetrical thanks to advances in digital 3D technology

bull Stable The stability of both shoulder and pelvic girdle facili-

tates the intermediate corrections

bull Transparent Skin pressures are easily observed and direct

control of the pushes stops drives and reliefs is possible Comple-

mentary pads are rarely needed

The Lyon Brace is always constructed after the completion of the

reductive plaster casting protocol using a Cotrel EDF frame The re-

sults of the Lyon Brace Management have been validated by numer-

ous teams in Europe However the plaster cast process is quite diffi-

cult for the patient and physician Consequently many teams looked

for more convenient and expedient solutions without preliminary

plaster cast reduction Moreover when the angular correction is low

the plastic deformation remains limited

h t t p s c o l i o s i s j o u r n a l b i o m e d c e n t r a l c o m articles1011861748-7161-6-4


It was only in 2013 that advances in computer technology with

the latest generation software (OrtenShape) allowed the superpo-

sition of different CADCAM shape captures and a segmental 3D

reconstruction The aim was to use this new software to replace the

plaster cast with a new Lyon brace the ARTbrace The Regional

shape capture is one of the fundamental innovations of the ART

brace The overcorrection is performed in the frontal plane and the

sagittal plane precisely and individually for each child at three levels

pelvis lumbar spine and thoracic spine The detorsion is obtained by

untwisting the whole spine

Like the historical Lyon brace the ARTbrace is ADJUSTABLE

Both axillary and pelvic clamps are adjustable with a precise wrench

and a bolt system and an anterior ratcheting buckle

Like the historical Lyon brace the SAGITTAL PLANE is fixed by

the posterior bar But the sagittal plane is determined by the regional

shape capture and the superposition of the 3 shape captures In addi-

tional it is the lack of support at the sternoclavicular level and at the

abdominal level that avoids lumbar delordosis and thoracic flat back

The initial aim was to avoid the plaster cast but very quickly the

ARTbrace appeared to be a much more effective solution compared to the former casts and it was even better tolerated Following the

early successes of in-brace correction (40 better in-brace correc-

tion) the whole treatment was continued with the same brace

httpsplayervimeocomvideo189456845

ISPO 2017 - Olomouc

History of Scoliosis Treatment and modern trends today

c h a p t e r 2

The interdisciplinary team approach

Since 2013 we had the opportunity to create an interdisci-

plinary team for the ARTbrace with commitment and con-

stant nurturing A careful planning from 2013 to 2018 was

established

The first goal was to use the ART as a plaster cast to maintain the

concept of plastic deformation During the regional shape captur-

ing the MD performs the correction which he previously carried out

during the plaster cast The CPO saves to the computer the 3 shape

captures and it lsquos at this moment that occurs the maximum exchange

of information

Since the first patients we realised that the ART was correcting

40 more than the formerly used plaster cast and we took the deci-

sion to continue the entire treatment with the ART also replacing

the old Lyon brace The ARTbrace project was born

As opposed to multidisciplinary interdisciplinary team work is a

complex process in which different types of staff work together to

share expertise knowledge and skills to impact on patient care It


was first described by Drinka (2000) Several practicians identified

methods of team practice which are used to match the ART bracing

1 Leadership and Management

Project Manager JC de Mauroy - Clinique du Parc Lyon

Product Manager Sophie Pourret - lecante Group

Team Manager Freacutedeacuteric Barral - Lecante Group

CADCAM Orten Collaboration Pascal Genevois - Orten

Liaison Engineer Alith Hoang - Orten

Patients partners Scoliose et Partage (Christine Chenot)

Commercial Management Steacutephane Lecante - Proteor

Group

All senior managers are international leaders in the field of sco-

liosis bracing

2 Communication

Scientific publications

Website

Newsletter

International training

All members of the team are choosen for their Communication

skills with the patient within the team and outside

3 Learning Training and Development

Two Training sessions were performed in 2015

Four Educational Sessions in Italy in 2015 (Piacenza Bari

Palermo)

All individual team members are motivated

4 Appropriate resources and procedures

Structures Lecante Bracing Manufacture Full Instantaneous 3D

CADCAM Orten EOS X Ray - Clinique du Parc Medical Orthopae-

dic Unit amp Radiology Unit

Weekly coordination during the Regional shape capturing (JCdM

SP)

Monthly Team Meeting (LBM)

All team members are working in Lyon

5 Appropriate skill mix

A full competent staff is constituted with mix and balance of

personalities

6 Climate

Innovation team culture of trust value contributions nurturing

consensus and inter professional atmosphere were created

7 Individual characteristics


Knowledge experience initiative knowing strengths and weak-

nesses listening skills reflexive practice desire to work on the same

goals are the main skills

8 Clarity of vision

Having a clear set of values that drive the direction of the service

and the care provided Portraying a uniform and consistent external

image

9 Quality and outcomes of care

Patient-centered focus outcomes and satisfaction encouraging

feedback capturing and recording evidence of the effectiveness of

care and using that as part of a feedback cycle to improve care

10 Respecting and understanding roles

Tasks and roles are well defined sharing power joint working

autonomy

The Scoliosis Team

The family and patients are also part of the chain The brace com-

pliance depends partly on them When they exist the alternatives of

different protocols must be discussed and the choice is made jointly

A chain is only as strong as its weakest link

c h a p t e r 3

New concepts

Mathematical Basis Circled Helicoid

The mathematical basis of the torso column is the cir-cled helicoid with horizontal generating circle described

by the French mathematician Robert Ferreacuteol For a circled helicoid

the Cartesian parameterisation is the parameterisation of the circle

with diameter carried by Ox with a center (a00) with a radius b

forming an angle alpha with the horizontal For torso column alpha

= 0


The aim is to get not only a straight spine but a reverse torso

shape capture opposite to scoliosis ie overcorrection of the scolio-

sis curvature This overcorrection is possible only if the vertebral

bodies are not distorted Otherwise we favour the correction accen-

tuating the asymmetry of pressure on the vertebral body

The main innovative features are in the acronym of ART

1 A stands for Asymmetry obtained with an overlay of three re-

gional shapes captures

2 R stands for Rigidity (in fact High rigidity) of polycarbonate

3 T stands for Torsion the brace performing a Detorsion of the

scoliotic Torso Column which is a circled helicoid with horizontal

generating circle in opposite direction of the spiral column while fix-

ing the sagittal plane in a physiological position

Asymmetry

Background

Although the effectiveness of bracing for scoliosis is now proved

(level 1) [Weinstein 2013] there are more than twenty types of

braces used worldwide All of them have not shown to be as effective

as the others A recent review found that Asymmetric braces have

led to better corrections than that described for symmetric braces

[Sy 2015] The efficacy of the brace also depends on moulding The

CAD CAM systems and especially those associated with Finite Ele-

ment Simulation [Cobetto 2016] have been proven to be more effec-

tive than the old plaster moulds [Wong 2011]

Symmetrical molding is easier to perform than asymmetric

molding If plaster casting is used the main effect is essentially axial

self-correction with possibly a lumbar shift In all cases the sagittal

curvatures are diminished Checircneau makes the corrections on the

positive plaster but without taking into account the rigidity of each

scoliosis These corrections are difficult if a constant volume is to


be maintained In fact the corrections are operator-dependent and

approximate which explains the use of polyethylene When using

CAD CAM systems It is necessary to differentiate the sensors type

ldquoIpadrdquo with precision of more than 1 cm probably less reliable than

the plaster or systems with raster-stereographie or the sensors with

4 columns almost instantaneous whose precision is of 1 mm Respi-

ratory blocking is then done in an intermediate position for children

and deep inspiration for adults

Aims

The aim of the asymmetrical ARTbrace is

1 To obtain the maximum asymmetry for each block (Katerina

Schroth block concept) lumbar and thoracic for two curves and

thoraco-lumbar for one curve by superposition of three asymmetric

shape captures codified and reproducible

2 To obtain the maximum precision (less than 1 mm) in the mini-

mum of time (less than 3 seconds) with the use of a professional

sensor This precision is also indispensable if one associates asym-

metry and high rigidity

Scope

The scope is to obtain the maximum in-brace correction by a

precise asymmetry using the new Regional Shape Capture with the

professional 4 column CADCAM

Rigid (very high) Polycarbonate

Background

Even if the old Lyon brace in polymethacrylate was very rigid

the credit for VERY HIGH RIGIDITY goes to the Italian team of

ISICO with the Sforzesco brace which has proven to be effective

by avoiding plaster casts for scoliosis over 45deg The acronym ART

brace (Asymmetrical Rigid Torsion brace) was created by Stefano

Negrini The merit of the ART brace is the addition of overcorrec-

tion to the high rigidity with a global detorsion It is this overcorrec-

tion for small curvatures which explains the average improvement of

the in-brace correction

Polycarbonate characteristics are

bull Transparency

bull Unbreakable (25 stronger than PPMA)

bull Lightweight (4 mm sheet)

bull No bisphenol A

bull Glass transition 147deg-155deg

bull Bending brake till 120deg

bull Insulation Rvalue 143

Aims


The aim of the high rigid asymmetrical ARTbrace is

1 To replace the plaster cast during the initial plastic deforma-

tion of the Lyon management

2 To improve the comfort in brace thanks to the soft contact

The Soft Contact concept is that of the squeeze attachment for cy-

lindrical hay bales Pressures are spread over the entire cylinder sur-

face this is contrary to the principle of the push and counter-push of

the historical Lyon brace or other three point braces

As usual in the correction of 3D deformities of the scoliotic

spine room should be provided for migration of lateral curvature

rotated vertebrae and breathing exercises In this design actually

various 3-point pressure systems are provided to correct the lateral

curvature and vertebral rotation from different anatomical planes

In the ART brace the shape of the brace is not a straight spine like

the Sforzesco or the old Lyon brace but an overcorrected spine with

reverse scoliosis

3 To realize the baby lift or lsquopullrsquo which is an axillary extension

that occurs in the armpits like when wearing a child

Scope

The scope is to achieve all the over-correction in the outer sur-

face of the brace which makes the inner surface smooth without

pads The brace then becomes dynamic with a lsquopullrsquo asymmetry

Torsion

Background

Global Detorsion vs 3 points system (Solid Geometry)

Given the multiplicity of planes the corrections by the 3 points

system only operate in a limited number of planes On the contrary

the ARTbrace works in an overall untwisting

The Global detorsion is performed with a fixed sagittal plane

Axial elongation brings the vertebral bodies near the central axis in

the frontal plane and by untwisting the scoliotic spine between the

pelvis and the shoulder the horizontal plane is corrected So both

geometrical detorsion and mechanical detorsion of the cylinder are

working together

19

18 bull J E A N C D E M A U R O Y C O N T E N T

Mayonnaise Tube Effect

The translation along the vertical axis is a fundamental step of

untwisting The concept of elongation has progressed during the last

century

1 Simple cervical traction against gravity it is more of a stretching

2 With Milwaukee this elongation is between the head and the

pelvis which provides elongation

3 With the Lyon brace elongation occurs between shoulder and

pelvic belts

4 With Boston it is the effect ldquocherry stonerdquo that is privileged

with the idea that correcting the bottom of the column will help to

correct the upper part of the spine

5 Finally with ARTbrace there is a real extrusion by bringing

together the two pieces (hemi-shells)


The principle of the wrench and bolt is to ldquounscrew or untwistrdquo

scoliosis For instance the Checircneau brace uses the principle of pres-

sure and expansion in many precise areas For a double major curve

in the ARTbrace the thoracolumbar area is the fixed point with un-

screwing between this fixed point and the pelvis for lumbar curva-

ture and the shoulder girdle for thoracic curvature For a thoraco-

lumbar curve the fixed points are at the cranial and caudal parts of

the spine and the unscrewing is done at thoracolumbar level The

pelvis is the laquobolt headraquo which is stabilised by a symmetrical pelvic

base like a key Lumbar and thoracic segments above act as a wrench

for the detorsion of scoliosis

The EOS 3D system automatically calculates the rotation for each

vertebral segment The twist (Torsion) is the sum of all the segmental

rotations We can calculate the overall in-brace untwisting

c h a p t e r 4

Principles of ARTbrace

1 PLASTIC DEFORMATION

Some definitions The relationship between the stress

and strain that a material displays is known as that materialrsquos

stressndashstrain 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)

In physics and materials science plasticity describes the defor-

mation of a (solid) material undergoing non-reversible changes of

shape in response to applied forces for example a solid piece of

metal being bent or pounded into a new shape displays plasticity

as permanent changes occur within the material itself In engineer-

ing the transition from elastic behavior to plastic behavior is called

yield

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 This is why we ask the patient to

remove the brace two hours before the X-ray


In materials science creep (sometimes called cold flow) is the

tendency of a solid material to move slowly or deform permanently

under the influence of mechanical stresses It can occur after a long-

time exposure to high levels of stress that are still below the yield

strength of the material

So Creep is the time dependent elongation of a tissue when

subjected to a constant stress For scoliosis 4 weeks are needed to

achieve sustainable elongation for a scoliosis under 30deg

The tissue response to load is dependent on 1 Magnitude of

load (quantity of hypercorrection) 2 Duration of load (from 1 to

4 months) 3 Prior loading (physiotherapy) The type of response

should be creep

The viscoelasticity is also a nonlinear system which is observed

in all soft connective tissues One of the characteristic of a visco-

elastic system is the creep which is a definitive modification of the

length of the ligament (plastic deformation vs elastic deformation)

Creep is obtained maintaining a continuous load of the structure

The tissue elongated rapidly at first and then continues to elongate

more slowly (This property may be used in the treatment of defor-

mities of the skeleton such as clubfoot or scoliosis where a constant

load with a plaster cast may be arranged to cause creep of the tissue

in the appropriate direction

From the 3rd week remodeling can be obtained The collagen

fibers gradually realign themselves to conform with the original

structure Clinically a minimum of 3 weeks of immobilisation are

necessary


Another example of creep can be provided by animal testing

This experience dates from the time of lateral electrical stimulation

of scoliosis If the spine of a rat is maintained for 5 weeks in lateral

bending a definitive structural scoliosis will be obtained

The initial full time and the in-brace over-correction allow the

plastic deformation which will restore the tensegrity of the spine

2TENSEGRITY RESTORATION

Tensegrity is a nonlinear concept of spine biomechanics

This concept of tensegrity completes the traditional physi-

ological concept against gravity developed by Newton

The name of ldquotensegrityrdquo was created by an architect Buckmin-

ster Fuumlller The Definition is ldquoIn biomechanics the tensegrity is the

property of the objects which components use tension and compres-

sion in order that strength and resistance are higher than the addi-

tion of its components Therefore muscles and bones act together

to be strongerrdquo

The tensegrity is a characteristic of terrestrial vertebrates Due to

gravity the initially functional frontal plane in aquatic environment

became sagittal Aquatic mammals as whales and dolphins which are

probably back in the water after a land phase have maintained this

sagittal function plane

Tensegrity is probably at the origin of bipedalism as we see since

the Rhesus monkey the transformation of ilio-lumbar muscles in

strong ligaments The vertebral column is not only made of piled

cubes but is a system with ligaments under tension like a ship The

muscle fascia is organized into chains that will cross at the thoraco-

lumbar junction for the frontal chains and at the pelvis for the sagit-

tal chains


Homo sapiens is the only one with a pubertal growth of about

25 cm of growth on the spine Quadruped vertebrates grow linearly

The growth plate is located at the vertebral body This growth is lim-

ited by paravertebral ligaments except in Marfanrsquos syndrome These

patients have a decrease in curvatures in the sagittal plane and a

thoracolumbar kyphosis We can say that the pubertal growth is the

primum movens of tensegrity and curvatures in the sagittal plane

Thanks to the tensegrity spine acquires an omnidirectional func-

tion allowing the practice of sports at a high level The maximum

tensegrity phase is between 15 and 35 years which is the great peri-

od of sports activity We will see the main characteristics of tenseg-

rity 1 The basic triangle structure which offers a best stability 2

The nonlinearity with rigid bone structure in discontinuous com-

pression and ligaments always in continuous tension 3 A Nonlinear

system means that a little modification of length (some mm) can

increase a lot strength and resistance of the whole system

The basic structure is the triangle which offers a best stability In

fact the paravertebral muscle structure as deep as superficial has a

triangular structure The posterior arch has also a triangular struc-

ture with transverse apophysis and median spinous apophysis The

muscular chains are working diagonally and in spiral

The intervertebral disc is also a structure of tensegrity with the

nucleus in compression and the annulus fibrosus in tension The ori-

entation of the concentric lamels of the annulus in reversed layer and

30deg inclined from the horizontal is a characteristic of the tensegrity

The maximum stability is obtained with a minimum of material

The pressure is distributed over the entire volume as the canvas of a

tent or a bicycle wheel If one of the rays doesnrsquot have a good tension

the wheel will be bent

Many muscles act as tensors and increase the resistance of the

whole spine The yellow ligament called this way because of its main

component elastin is the elastic of the spine A bad healing can ex-

plain an instability after surgery The objective of the Lyon brace

is to tighten and rebalance tension by straightening the main mast

which is the spine

The tensegrity principle is universal When the nucleus of the

carbon is organized in an icosahedral structure The graphite turns

into a diamond

The matrix has also an interconnected structure Stress is ab-

sorbed by the core and produces a reaction of molecular rigidity due

to the increase of the tension

The concept of tensegrity explains the role of the plastic defor-

mation which realizes a real ligament lengthening at the concavity

level Four weeksrsquo minimum of continuous tension are necessary

to obtain a lengthening of the ligament otherwise the ligament re-

mains at the elasticity level Another important consequence of high

rigidity is the discontinuous pressure during breathing and move-

ment on the thoracic cage This discontinuous pressure on the bone

structure is the same as tensegrity


So we have a new pattern of the spine It is the soft tissues around

the spine under an appropriate tension which maintain and can lift

all the spine The spine is no longer a column a pile of vertebrae but

a tensegrity structure The paravertebral ligaments are always in ten-

sion when the spine is at rest The length of the paravertebral mus-

cles at rest is such that they are always under tension The vertebrae

and the discs are in discontinuous compression The 206 bones are

working in discontinuous compression they are lifted in the gravity

field by the continuous tension of muscles fasciae and ligaments

A tensegrity structure works if all vertebral segments are inde-

pendent Physical therapy and manual medicine will compensate the

stiffness associated with scoliosis but also with the plaster cast and

the brace

On the contrary surgery removes segmental motion The col-

umn will be rectified but tensegrity and omni directionality of the

fused spine is lost

33D COUPLED MOTION OF THE SPINE

The correction during the regional shape capture is done

only in 2 planes frontal and sagittal It is the restoration of

the lumbar lordosis and the sagittal kyphosis which allows a good

alignment of the posterior joints and a mechanical derotation in the

horizontal plane (Laws of Penjabi and Fryette)


Bangalore 2017

3D nature of scoliosis

Usually conventional braces with 3 points systems decrease lor-dosis and thoracic kyphosis Untwisting the spine with ARTbrace is

done maintaining the curvatures in the sagittal plane1 Indeed the

screw is not straight but curved However curving the screwdriver

is useless The new solution is the shape capture in frontal bending

which respects lordosis and kyphosis and allows untwisting whilst

retaining the curvatures in the sagittal plane The spine in the sagit-

tal plane is fixed as physiologically as possible Only the frontal and

horizontal planes are mobile

4 4D Global correction of the ARTbrace

The mechanical action of the ART brace is carried out

bull Along the vertical axis of the spine In the three sag-

ittal frontal and horizontal planes of the spine In the ART brace

the reference plane is the horizontal plane at the thoraco-lumbar

1 SOSORT guileline ldquoIt is recommended that the brace proposed for treating a scoliotic de-formity on the frontal and horizontal planes should take into account the sagittal plane as much as possible

ldquo

R E F E R E N C E M A N U A L F O R T H E A R T B R A C E bull 31

junction The anterior and posterior muscle chains in the frontal

plane intersect at this level The middle brace closure with ratchet-

ing buckle must be strict The elongation along the axis of the spine

is carried out during the first shape capture The spring effect moves

the apical vertebrae near the spinal axis This is the correction of the

internal geometric vertebral torsion

bull This classical elongation in braces such as the Milwaukee

brace has the disadvantage of reducing the curvatures also in the

sagittal plane Segmental shape captureings in the lumbar and tho-

racic areas overcome this disadvantage and reproduce physiological

curvatures in the fixed sagittal plane

The correction in the horizontal plane is on the whole external

surface of the trunk (mechanical detorsion)

In the case of a double curvature there is a first untwisting be-

tween the pelvis and the reference thoraco-lumbar plane and a sec-

ond untwisting between the reference plane and the shoulder girdle

The correction in the frontal plane is also exerted on the en-

tire external surface of the trunk It is the shift that is achieved with

shape captureings 2 and 3 which allows this correction The transla-

tion is at the apical vertebra level and not below as in the old Lyon

brace For a single thoraco-lumbar curve it is the reference thoraco-

lumbar plane which ensures derotation of the entire trunk between

both pelvic and scapular planes The lever arm is more important

and the curve is therefore better corrected In the frontal plane it is

also the reference thoraco-lumbar plane that will translate between

both scapular and pelvic girdles Lumbar and thoracic shifts take

place in the same direction

The 4D global correction of ARTbrace occurs during the day

and the movement is obtained by balancing among both frontal and

horizontal anatomical planes The inversion of the curvatures auto-

matically creates an expansion in the concavity that allows the 4th

dynamical dimension ie Contact during movement and breathing

5 THE BEST OR NOTHING

The guidelines Ndeg 16 of SOSORT can be confusing ldquoIt is

recommended to use the least invasive brace in relation to the

clinical situation provided the same effectiveness to reduce the psy-

chological impact and to ensure better patient compliancerdquo More rigid

does not mean more invasive The strategy of ldquostep by steprdquo ie a

less corrective brace for a small angulation and a very rigid brace for

a larger angulation is not used in current practice of Lyon manage-

ment The risk of failure culture with progression to braces more and

more rigid is often misperceived by children and parents The use of

the brace immediately the most effective with partial time wearing

was preferred For the same effectiveness the psychological impact

is reduced by partial time wearing and compliance is improved


Global presentation of the ARTbrace


APOSM 2016 3D Correction of the ARTbrace


c h a p t e r 5

Brace prescription

The goal of the Lyon bracing management is to allow non-

operative treatment of scoliosis by preventing progres-

sion of the scoliosis in the growing child A better under-

standing of the natural history of idiopathic scoliosis has refined

the indications for brace treatment Brace treatment begins when

the probability of the progression of scoliosis is high The patient

with a mild curve near the completion of growth is unlikely to have

further progression of the scoliosis and probably does not benefit

from wearing a brace

Chaotic amp Linear Scoliosis

Below 20deg scoliosis is more often a deviation which can be re-

versible For now it is impossible to predict the evolution This stage

is called chaotic scoliosis Beyond 20deg-25deg there is a structural de-

formation during growth which will cause the vicious circle of sco-liosis described by Ian Stokes

The linear evolution of the scoliosis has been described by Ms

Duval Beaupegravere To avoid over treatment we do not brace in chaotic

phase

The preadolescent with a moderate scoliosis (curvature gt30deg) is

at significant risk concerning the progression of the scoliosis and

may derive a great benefit from wearing a brace (Virtuous Bone circle)

The adolescent with a 45-degree curvature and growth remaining

may achieve curve control with bracing or can be served by surgical

treatment In general for the adolescent with a curvature of 25-45deg

degrees and growth remaining Lyon bracing management is indi-

cated and will stop progression of the curvature in 55 of patients

it will improve curvature in 35 and curve progression will continue

in spite of bracing in 10 Bracing large curves in the younger child

may delay surgery and allow further spinal growth before fusion In

juvenile idiopathic scoliosis brace wear is initiated when the curva-


ture exceeds 20deg In the adolescent or late onset idiopathic scoliosis

the following guidelines are suggested by SRS

Approximate guidelines for brace treatment of Adolescent Idiopathic Scoliosis (Juvenile curves should

be braced much earlier- probably if over 20deg)

0deg - 20deg Observe for progression20deg - 25deg Brace if substantial progression documented25deg - 30deg Brace if progressive and growth remains30deg - 40deg Brace if less than 1 year after end of growth 40deg - 45deg Brace If less than 2 years after end of growthgt 45deg If family refutes surgery

Curve Location

The Lyon brace makes it possible to treat all curves except pri-

mary high thoracic curves for which we advise the use of the or-

thotic device of Milwaukee Fortunately this pattern of scoliosis is

less evolutive than others

Hypokyphosis and Thoracic Lordosis

The restoration of thoracic kyphosis requires

- The stability of the lumbar spine in lordosis

- The anterior xiphoidian stop

- Bending of the posterior and anterior bars

Contra indications to bracing

1 Severe thoracic lordosis (thoracic kyphosis lt 0deg) is a contrain-

dication to brace All braces that apply transverse forces with pos-

terolateral push on the spine via a rib articulation may worsen the

lordotic spine Surgical Treatment is recommended for progressive

curves with true thoracic lordosis

2 No participation from patient and family The Lyon brace re-

mains an elitist treatment When the child and his family accept the

plaster cast or ART full time (in approximately two thirds of the

cases) the part time bracing which follows will be well accepted It

appears useless to us to spend money for a brace not to be worn and

when the scoliosis evolves it is better to consider surgical treatment

3 Morbid obesity may make effective bracing for scoliosis im-

possible The brace is designed to grip the pelvis bony prominences

and large amount of growth remains otherwise observe (night time

bracing)

4 Psychological Reaction

5 In-brace reducibility lt20


Bangalore 2017

Kyphosis - Clinical amp Radiological Assessement


c h a p t e r 6

Regional Shape Capture

Biomechanical Basis Coupled Movement

The biomechanical basis according to Panjabi is the cou-pled motion behaviour of the spine The shape captureing is

2D but the correction is 3D

The direction of rotation may differ depending on the incurva-

tion of the spine in the sagittal plane When there is a flat back the

initial scoliotic rotation may be increased by the correction in the

frontal plane Restitution of physiological curves in the sagittal plane

seems to decrease the scoliosis rotation (Harrison Fryettersquos laws)

Principle I When the spine is in a neutral position sidebending

to one side will be accompanied by horizontal rotation to the op-

posite side

Principle II When the spine is in a flexed or extended position

(non-neutral) sidebending to one side will be accompanied by rota-

tion to the same side

Although these laws have not been described in the context of

scoliosis we often see an accentuation of the rotation during pre-surgical bendings in supine position

Specific Device with Visual Control of Alignment

Today the majority of the CAD CAM moldings are carried out

using the ldquoStructure Sensorrdquo adapted especially on the ipad The

precision of this sensor is of the order of 1 cm insofar as the circle

described around the child is perfect and especially that the child

does not move during the 15 seconds necessary to complete this

circle Such inaccuracy is not suitable for the very high rigidity of

the polycarbonate

To obtain a torso column on the opposite side of the scoliosis the

superposition of three electronic instantaneous full 3D shape captu-

reings is necessary These shape captureings were made with the full

3D instantaneous raster stereography digitiser Orten Markers are

placed on the optical jersey

bull On the front at the upper and lower part of the sternum and

at the antero-superior iliac spine

bull On the back on a point on each vertebral spinous process

A visually monitored control with a posterior and profile view is

mandatory to obtain the ideal posture and bench marks on the opti-

cal jersey facilitate the reconstruction

Sagittalometer Assessment

The basic use of sagittalometer is the calculation of the pelvic in-cidence Pelvic incidence is a constitutional factor and does not vary

according to the movements in the sagittal plane

Depending on the angle of pelvic incidence sagittalometer in-

dicates the theoretical value of the sacral slope (shape capture 1)

lordosis (shape capture 2) and kyphosis (shape capture 3)


1st shape capture (self-elongation amp pelvic tilt modificator )

The First shape capture is performed in self active axial elonga-

tion from the pelvis to the shoulders Pelvic version and harmony of

curvatures in the sagittal plane are monitored carefully but without

trying to correct them

2nd shape capture (lumbar shift and lordosis modificator)

The second shape capture is performed in lumbar shift and

physiological lordosis for the lumbar spine On the concave side the

axillary-trochanter line is vertical

3rd shape capture (thoracic bending and kyphosis modificator)

The third shape capture is performed in thoracic shift and physi-

ological kyphosis for the thoracic spine On the concave side the ax-

illary-trochanter line is vertical To improve the high thoracic shift

the hand is placed on the head which bows towards the concavity



Reacutegional shape capture -

case 682

c h a p t e r 7

Brace construction

Modelling of the trunk shape with shapes overlay

These modifications are made using the software

OrtenShape In the frontal plane shape capture 2 is su-perimposed on shape capture 1 then shape captureing 3


Similarly in the sagittal plane the second shape captureing is

superposed on the first one then on the third shape captureing

Changes are made at constant volume and detorsion which is a result

of both corrections in the frontal plane and the sagittal plane

The ARTbrace is constructed with 2 rigid asymmetrical lateral

pieces of polycarbonate They are connected posteriorly at the mid-

line by a duraluminium bar like the historical Lyon brace

All metal parts are similar to those of the old Lyon brace Both

anterior and lower ratcheting buckles are rigid the upper third is

Velcro The brace is not in complete contact with the body there is

an expansion in the concavity which is there to allow room for the

bodyrsquos expansion during inhalation

Specific design and curve pattern

A specific classification is not used indeed most classifications

were developed for surgery For bracing a specific classification was

developed by Rigo for the specific needs of the RSC brace

bull For the ARTbrace the sagittal plane pelvic tilt and axial

balance are strictly controlled The only modifications concern the

frontal plane

bull For a single thoracic curve the second shape captureing is

used only if the lordosis of the first shape captureing is incorrect and

if this is the case we do not need the frontal shift

bull For a single thoraco-lumbar curve both thoracic and lumbar

shifts will be made in the same direction

bull For a double curve the horizontal plane of overlay is at the

level of the transitional vertebra usually at the lumbosacral junction


bull For a double thoracic curve we give priority to the main rib

hump mainly the lower curve and in this case the plastazote pad

will be used to control the upper curve

If the shoulders are unbalanced it is also possible to make the

upper end of the brace asymmetric at the axillary level like the his-

torical Lyon brace

No specific segmental derotation is required as the ARTbrace

causes a global helical untwisting

THE SPECIAL CASE OF INFANTILE SCOLIOSIS

The ARTbrace was created to replace the plaster cast in the Lyon

management for AIS It was therefore tempting to use it to replace

the serial casting for infantile scoliosis Infantile scoliosis are rare

and a study of two cases is the most useful to illustrate the prob-

lems infantile scoliosis might cause The first problem has been the

miniaturisation of the brace with a use of a 3mm polycarbonate

The posterior metal bar was reduced in proportion so as the ante-

rior closures The second problem is the impossibility of achieving

the regional shape captureing for children under 3 years which can-

not maintain asymmetric postures The problem is solved by using

the mirror technique The first shape captureing is realised in pas-

sive axial elongation meaning reducing the curvature by pulling the

child by the upper limbs During the superimposing step we invert

the image creating a reverse torsion of the initial scoliosis Thus a

major expansion in the concavity is performed for asymmetrical

correction of scoliosis and breathing

The story of Olympe

Early Onset Scoliosis was discovered at the age of 2 years with

a right thoracolumbar curve At the age of 3 years the curve is 30deg

Olympe was not compliant with the first Milwaukee that was quickly

replaced by an asymmetrical polyethylene TLSO well-worn during 3

years Despite bracing the scoliosis is still progressing to 42deg with-

out brace and in-brace correction is 25deg At 8 years old it was pos-

sible to achieve the classic regional shape captureing in 3 steps The

in-brace correction is complete at 5deg At the six months follow-up


the angulation without a brace is 17deg a little better than under the

TLSO Olympe prefers the polycarbonate

The story of Adele

Adele two and a half years old lives in a North West town of

France At the age of three months her left infantile scoliosis is dis-

covered Her Scoliosis is highly progressive because the curve T6-

T12 reaches 95deg on May 31 2015 A serial casting from May to July

was realised and then a TLSO brace adapted MD and CPO are doing

their best but the correction is limited to 60deg The CADCAM Mir-

ror technique was used The in-brace angulation is reduced at 36deg

(62) the child is well balanced in the frontal plane and the kypho-

sis is corrected in the sagittal plane


Untill now there were not many alterna-

tives to sequential and repetitive surgery

for infantile scoliosis The 3mm polycar-

bonate seems to be able to replace the

Min Mehtarsquos serial casting and the poly-

ethylene TLSO

By comparing the results obtained in the same infantile scoliosis

by a conventional TLSO and the ART it is possible to better appreci-

ate the technology differences In both cases the results seem to be

better for the 3mm polycarbonate

ADULT SCOLIOSIS

Scoliosis is a major demographic health issue in the adult popula-

tion with pain imbalance and angular curve progression In a series

of 158 adult scoliosis treated by classical polyethylene brace and re-

viewed on average 8 years after the start of treatment the natural

angular evolution of scoliosis is halted in 80 of cases However

it appears that current braces fail to stop the kyphotic evolution of

adult scoliosis and justifies the improvement of existing braces As

the high rigidity of the ART 4 mm polycarbonate is better tolerated

by children than the conventional polyethylene it was logical to use

the new concepts of ldquobaby liftrdquo and overall untwisting for adults The

first encouraging results justify this presentation especially as there

is to date no other solution As with adolescent scoliosis we use


the regional shape captureing The third shape capture is made in

maximal inspiration because the expansion in the concavity is lower

than for children The visual control of the instantaneous 3D scan

allows a perfect alignment in the frontal and sagittal plane The su-

perposition of the three shape captureings is carried out by the spe-

cific OrtenShape software The usual wearing protocol of the brace

is of 4 hours a day As adult patients are evolving in kyphosis the

posterior axillary support is lower than for children Similarly the

anterior abdominal expansion due to the restoration of lordosis im-

proves tolerance An ARTbrace was performed in 32 adult patients

from February to November 2015 Although there are difficulties

for the camptocormia all patients appreciate the anterior closing by

the ratcheting buckle of the ART One of our patients passing from

polyethylene to polycarbonate sums up the situation ldquoBefore I car-

ried the brace now the brace carries merdquo

Our first case is a lady born in April 1931 She has a thoraco-lum-

bar scoliosis (T11-L3 52deg) and especially a high thoracic kyphosis of

88deg with significant walking difficulties The result is kyphosis in-

brace correction at 48deg and scoliosis at 38deg Unfortunately the brace

is worn less than 4 hours per day as she has leukaemia


Our second case is an aging patient treated by the former poly-

ethylene bivalve brace with sterno clavicular support She presents

a scoliosis T5-T12 80deg T12-L4 60deg Since an accident in 2013 the

former brace is no longer suitable A hip flexion and a pelvic retro-

version are compensating partially the high thoracic kyphosis The

ART adult is completed in March 2015 From the beginning twist-

ing sensation disappears less lumbar pain she is able to climb three

floors without breathlessness At the 6-month follow up the brace

is worn every morning is very well tolerated and the high thoracic kyphosis is improving at 45deg

In conclusion the adult ARTbrace has the advantage of correct-

ing scoliosis as well as kyphosis The lateral thoracic support is better

tolerated than the sternoclavicular support of a sagittal 3 points sys-

tem The anterior closure is a benefit to patients The absence of ab-

dominal compression limits the bladder and digestive complications


MANUFACTURING


FITTING AND FABRICATION OF THE ARTBRACE

Trim Lines

The anterior space between the two pieces is about 2 cm

The cutting at the breast level is wide to avoid compression

The anterior inferior cutting is higher than for the old Lyon brace

It is at the level of the Antero-Superior Iliac apophysis

The posterior cutting allows the opening of the brace like a book

However the opening is always partial because the two hinges are

not in the same frontal plane The cutting is wider in the concavity ie in the opposite direction of scoliosis which facilitated the opening

and allows some manual control for the physiotherapist

The posterior-inferior cutting is at the level of the acetabular roof

The posterior-superior cutting is very high especially in case of

flat back

From a lateral view the axillary line is inclined from 10deg to 20deg

on the horizontal the posterior part being higher than the anterior

c h a p t e r 8

Management of the patient with ARTBrace

How to check the braceClinically the height of the child in brace is measured

because the gain in height is an average of 158 cm due

to the untwisting of the spine This is an excellent clinical indicator

of the effectiveness of the brace In the sagittal plane alignment of

Tragus ndash Acromion - Trochanter - Ankles is checked

Frontal and sagittal X rays are performed 3 to 4 days after fitting

the brace with the ultra-low dose EOS system which also allows a 3D

reconstruction if necessary

The metal bar must be vertical in the frontal plane and the C7

axis well balanced

Adjusting the brace is made in the supine position The middle

ratcheting buckle is checked at the chondro-costal level The tighten-

ing of the lower ratchet closure does not compress the abdomen but

stabilizes trochanters Upper Velcro closure must be tight enough to

prevent the tingling in the upper limbs


It is always possible to add on a plastazote pad inside the polycar-

bonate but in practice this is an exception Indications of the sitting

posture are given with feet behind the chair buttocks in front of the

seat polycarbonate touching the edge of the table and forearms on

the table

In the ARTbrace the fixed point is the lower part of the thorax

at the thoracolumbar junction The dynamic movement of the poste-

rior part of the spine is better in this posture It is the fourth dimen-

sion of the brace The child will relax in the listening posture on the

back of the chair Alternating these two extreme postures seems to

be more dynamic

Follow-up and Management

1 - First initial Control 6 months after the end of full time

Curve STABLE --gt Decrease during the day by

blocks of 4 hours

Curve UNSTABLE (elasticity of

more than 10deg)

--gt No Change

Curve Worsening of more than

5deg

--gt No change + 1 month full

time every year

2 - Next Control every 6 months

Same protocol till reaching 8 h24 = Night time

How to determine the weaning time

The Risser test is not a very good test when the brace regularly

presses on the iliac crest We use more simply the measurement

of standing height barefoot When the size no longer changes the

weaning time depends on the maximum reached by the scoliosis

angle

1 Below 30deg Removal at the end of linear growth

2 Between 30deg and 40deg Removal 1 year after the end of growth

in stature

3 For more than 40deg Removal 18 months after the end of

growth in stature A 6 months test ab-

lation during the summer is then pro-

grammed In general at the end of the

school year in June for Europe (heat)


The child is followed in January of the following year If the elas-

ticity is below 10deg we confirm the final ablation If the elasticity

is greater than 10deg a recovery of the brace during night time for a

further 6 months may be considered

Physical therapy management (PSSE)

Physiotherapy has remained the same but the brace asymmetry

and preparation for segmental shape captureing are closer to asym-

metric methods and probably the current protocol will be adapted

in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9

Instructions for wearing the ARTbrace

Protocol and every day usage Initial Full Time

Similarly to the plaster cast the total time is advised with

weaning of a maximum of 10 minutes allowed for a shower

Unlike clubfoot treated by serial casting according to the Ponseti

method there is little data in the literature regarding the time re-

quired to achieve a creep of the concavity in scoliosis

The Lyon experience is as follows below 30deg scoliosis the total

time is 1 month The time required is two months for scoliosis be-

tween 30deg and 39deg and 4 months for scoliosis of more than 40deg

Indeed continuous stretching for more than 3 weeks is neces-

sary to permanently change the length of a ligament (creep) as for

an ankle sprain If the brace is removed for more than one hour

the viscoelastic structures return to their original length with only

elasticity

Physiotherapy is essential throughout the total time period it is

identical to that which was recommended with the plaster cast


Sport is permitted with the brace and even recommended to bet-

ter adjust the tension of the muscle chains When the paraspinal

musculature is active it creates a pre-stressed beam along the spine

which protects the vertebral body from collapsing

Protocol and every day usage Partial Time

The protocol of brace wearing is precised during the first consul-

tation according to the angulation of the curves and is confirmed if

the in-brace reducibility is more than 50

The brace wearing time can be increased if the reducibility is less

than 50

When the patient is seen six months after the full time wearing

it is possible to appreciate scoliotic elasticity (difference between

in-brace angulation and Cobb angle without a brace at 6 months)

When the elasticity is less than 10deg the protocol provides a decreas-

ing of the wearing time of further 4 hours during the day When

the elasticity is greater than 10deg the same protocol is maintained

or exceptionally the wearing time is increased We proceed in the

same way to the next check until the last step which is the night time

wearing

Practice of sport The weaning is authorised without any time limitation for the

practice of sport

Generally we advise the sports favouring the tonification of the

muscular ligamentar paravertebral structure during puberty growth

such as swimming climbing From the first period and when the

body is fully developed

When the body is fully developed we advise high impact sports

such as running dance to favour the fixation of the calcium on the

bone and the constitution of an important bony mass

In a specific way when the ribs are asymmetric we recommend to

avoid deep and quick inhalation which favours the vertebral rotation

and therefore the breathlessness during the practice of sports

For lumbar curves we advise as well against the quick flexions of the trunk forward or the position extending with an anterior flex-

ion of the trunk

Body cares

Perfumes and chemical colourings have to be avoided and use a

neutral soap or alcohol is better The undershirt under the brace is in

cotton long enough to cover the pelvis and if possible seamless like a

T shirt In France 8 under shirts like the one described are delivered

with the brace

Alimentation

The straightening up of a scoliosis can modify the oesophagus

gastric passing through the diaphragm

The inflation of the stomach has to be reduced by spreading

meals throughout and avoiding all fizzy drinks

Sitting position

We have to dissociate the laquo listening raquo sitting position feet for-

ward ischion behind the bottom and back against the dorsal sup-

port from the ldquowritingrdquo sitting position feet backwards ischion in

front of the bottom brace against the anterior edge of the counter

the two forearms lying on the desk


At night

The mattress has to be thick a little pillow stabilizing the cervical

spine If the patient complains of a superior member dysaesthesia

we have to use a second pillow to move aside the arm in abduction


ART Spirometry


ART Quality of Life

c h a p t e r 1 0

Results amp discussion

Methods

Study design

This is a prospective controlled cohort observational study based

on ongoing database (from 1998) including 544 patients with AIS

treated thanks to the ARTbrace from May 2013 to November 2015

A historical retrospective case series of 100 consecutive scoliosis

treated with the old Lyon brace management was used for compara-

tive purposes These are the last 100 patients treated before May

2013 only primary curves were selected lumbar curves Lenke 5 are

excluded as they are treated with the short GTB brace

Protocol

Brace checking is performed 3-4 days after brace delivery with

ultra-low dose EOS system

Statistical Analysis

The statistical analysis has been conducted with SPSS v20 For

all variables normality of data was ascertained by the Kolmogorov-

Smirnovrsquos test All analyses were performed according to the inten-

tion-to-treat principle All tests were two-sided with significance set

at p lt 005 Results are presented as mean plusmn standard deviation (SD)


To measure the effectiveness of a brace two main factors can be

involved

1 The immediate in-brace reduction depending how to get the

three-dimensional correction and its reproducibility

2 The patientrsquos adherence (compliance) which depends on aes-

thetics and tolerance

In-brace Correction for the 141 first patients with SRS criteria

All 141 patients was reviewed at the control no drop out

The mean age was 1292 years (SD=139 range 10ndash15) 125 pa-

tients are female (887 )

n = 141 Cobb init In-brace correction

Thoracic (98) 3033deg plusmn 46 1004deg plusmn 72 677 plusmn 212

Lumbar (75) 2861deg plusmn 41 636deg plusmn 65 788 plusmn 213

Total (141) 2962deg plusmn 46 845deg plusmn 71 725 plusmn 219

A Spearmanrsquos rank-order correlation was run to determine the

relationship between initial thoracic angulation and in-brace cor-

rection (Percent) There was a strong positive correlation between

initial and in-brace correction which was statistically significant (r

= -339 p = 001)

There was also a strong positive correlation between initial and

in-brace correction for lumbar curves which was statistically signifi-

cant (r = -296 p = 001)

For the BrAIST study average in-brace correction was 33

(n=152 range -48 to 100 )

Sagittal Correction

The radiological follow-up of old Lyon braces was performed

without lateral X-ray and therefore it is not possible to make a sta-

tistical comparison But thanks to the use of the micro dose EOS

system a systematic sagittal analysis was possible for the main group

of patients (ARTbrace)

In a previous study we showed that the average thoracic kypho-

sis angle with the upper limit T4 was 37deg For this study we set the

cut off at 30deg for hypokyphosis or flat back

The results are the subject of a separate presentation we can sum-

marise in the following table

T4-T12lt30deg Cobb init In-brace 1 year

73148 (494) 196deg plusmn 68 2845deg plusmn 58

50 1858 plusmn 66 2806 plusmn 545 2715 plusmn 54

The in-brace improvement is 9deg (rate 50 ) and very significant

(p = 0000) and without brace at the last 1 year follow up the im-

provement rate is 46 (p = 0000) There was no statistical differ-

ence between the in-brace group and 1 year after when not wearing

a brace (p = 0289) The in-brace improvement is therefore main-

tained at the 1 year follow up when the brace is off

38 of patients showed an improvement of 10deg or more 36 of

patients showed an improvement between 5deg and 9deg 26 of cases

with stability no back flat worsened

Progressive Improvement in 1 year

Cosmetic Results at 1 year

The aesthetic results were evaluated at 1 year comparing them

with those obtained by the former Lyon protocol The improvement


in ARTbrace is statistically significant They were evaluated at T0

(initial) and T2 (1 year monitoring) for the rib hump and ATR (an-

gle of trunk rotation)

End Treatment Results at Weaning for the first 73 patients

The dropout rate calculated for the first 125 patients is 14

The mean age is 1444 years (SD=132 range 10ndash17) 62 patients

are female (85 )

Cobb Init In-brace Weaning

2684deg plusmn 71 619deg plusmn 83 (794 plusmn 266)

1889deg plusmn 94 (530 plusmn 256)

Out of 100 curvatures (45 thoracic and 55 lumbar) no curvature

is worsened by more than 5deg 17 are stable and 83 have an improve-

ment of more than 5deg

Correlations

There is a negative correlation between initial angulation and end

treatment percent correction r=-0414 n=43 p=0001 for thoracic

curves and less r=-0292 n=53 p=0034 for lumbar curves

There is a strong positive correlation between in-brace correc-

tion rate and end treatment correction rate r=0684 n=43 p=0000

for thoracic curves and r=0596 n=53 p=0000 for lumbar curves

In our experience the weaning results are very close to those 2

years after weaning and can be considered as significant Patients

are a little older (144 vs 134) and with lower initial angulation than

in the general statistics (2684 vs 2961) The in-brace reduction is

greater (794 vs 694) which explains the outstanding weaning

correction rate (50 vs 25 for the old Lyon brace)

CONCLUSION

For the same indications and with the same management prin-

ciples we can confirm that

1 The early treatment with low angle

2 The quality of immediate in-brace correction

is fundamental to a successful outcome

Discussion

Castro studying a prospective cohort of 41 AIS concludes that

the brace treatment is not recommended with patients whose cor-

rection is less than 020 in TLSO

Appelgreen in an article detailing measurement of the Cobb

angle from the end vertebra in 121 AIS concludes that an average

in-brace correction of 030 gives hope a correction at the end of

treatment

Landauer studying the predictive criteria of conservative treat-

ment results in the first 6 months of treatment wrote that compli-

ant patients who have a high initial correction greater than 040 can

expect a final reduction of about 7deg and bad compliance is always

associated with curve progression

Wong comparing the results of the electronic shape capture of

20 patients versus the traditional plaster shape captureing of 20 oth-

er patients noted an improvement in the in-brace reduction from

032 to 042 in support of CADCAM shape captureing

Bullmann presenting the prospective results of 52 patients treat-

ed with the Checircneau-Toulouse-Muumlnster brace with curves between

25deg and 40deg estimated the in-brace correction at 043 There was a

positive correlation between flexibility and Cobb angle correction

during brace treatment and a negative correlation between Cobb

angle correction during brace treatment and curve progression


In the sagittal plane the correction obtained in the flat back is

unique today Indeed most authors consider that the correction in

the frontal plane is related to axial stretching accentuating the flat

back With the ARTbrace there is certainly an extension but the

main part of the correction is made by unscrewing or untwisting the

spine with translation of the vertebral bodies near the midline


Bangalore 2017

ART Results in the Frontal plane


ART Results in the horizontal plane


ART Results in the Sagittal

plane

c h a p t e r 1 1

Conclusion

After more than four years using the ARTbrace we can sum-

marise some improvements (in alphabetical order)

4D action hypercorrection action in the frontal and horizontal

planes during breathing and motion

Aesthetics the brace is transparent almost invisible under cloth-

ing However the asymmetrical ARTbrace is less aesthetic than the

symmetrical Sforzesco brace

Economy no more plaster casts no more hospitalisation and the

life-span of the brace is greater than that of the plaster cast

Efficiency the brace is adjustable in the frontal plane an addi-

tional correction by internal pad is easy

Hygiene a daily 15 minute shower is possible

Insulation the polycarbonate is more insulating than the glass

and there is no need for perforation

Lightness it is the end of 5-7 kg plaster casts and the ARTbrace

is 25 lighter than the historical Lyon brace

Originality this is the first untwisting brace of the whole spine

in three planes of space


Simplicity anyone can make a frontal bending with lordosis or

kyphosis no major correction of the positive shape capture is neces-

sary like the Checircneau brace

Tolerance polycarbonate is biologically well tolerated

Universality it is possible to correct hyperkyphosis like

hypokyphosis

These results can not still predict the final outcome but during

the last 50 years the immediate in-brace reducibility of scoliosis re-

mained around 050 and progress focused on aesthetics and toler-

ance Thanks to advances in computer graphic technology this cor-

rection exceeds for the first time 070 with the ARTbrace

This correction requires no more significant alteration of the

positive shape capture but the superposition of three segmental

CADCAM in a simple and strictly defined posture

Improving the flat back in the sagittal plane has never been de-

scribed with scoliosis braces used to date

Lyon brace management and protocol are not modified by the

use of the ARTbrace and a priori the final results of the treatment

cannot be worse than the historic Lyon brace

While the ARTbrace could be defined as a modified or ldquonewrdquo

Lyon brace the new concepts and first results prove that it can com-

pletely replace the casting and old Lyon brace process it really de-

serves to be recognised as its unique design has surpassed its prede-

cessor and former protocol

Further results will be inserted progressively in this book

The best BRACE does not exist but the best in-brace correction doesAnnex 1 Comparative tables of different materials

Soft Polyeth-

ylene

Polycar-

bonate

Comment

Frontal 38 43 70 In-brace

Sagittal No publi-

cation

-3deg +8deg Flat back

Rotation

(apical)

+++ +++

Torsion

(Global)

++ +++ Need high rigid

upper point

A x i a l

Elongation

0 ++ +++ 18 cm

Contact Strap Pads Soft

Efficiency 0 ++ ++++ (cost)

Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++

Tolerance ++++ +++ ++++ Initial full time

Invasive + + ++++ +++ Soft contact

Versatility ++++ + ++++ Plan B night

overcorrecting

Easiness ++++ ++ +++ Full 3D

instantaneous


Repeatabil-

ity

+ ++ ++++ 3 regional

moulading

Precision ++ ++ ++++ High Rigid

Adaptation

time

1 hour +

physio

3 weeks 3 days Initial full time

Bibliography

ldquoBrace Technologyrdquo Thematic Series - The Lyon approach to the

conservative treatment of scoliosis de Mauroy JC Lecante

C Barral F Scoliosis 2011 Mar 2064

Prospective study and new concepts based on scoliosis detorsion

of the first 225 early in-brace radiological results with the

new Lyon brace ARTbrace Jean Claude de Mauroy Cyril

Lecante Freacutedeacuteric Barral and Sophie Pourret Scoliosis 2014

919

Actual evidence in the medical approach to adolescents with idio-

pathic scoliosis Negrini S De Mauroy JC Grivas TB Knott

P Kotwicki T Maruyama T OrsquoBrien JP Rigo M Zaina F Eur

J Phys Rehabil Med 2014 Feb50(1)87-92 Review

Bracing for scoliosis in 2014 state of the art Zaina F De Mauroy

JC Grivas T Hresko MT Kotwizki T Maruyama T Price N

Rigo M Stikeleather L Wynne J Negrini S Eur J Phys Reha-

bil Med 2014 Feb50(1)93-110 Review

The new Lyon ARTbrace versus the historical Lyon brace a prospec-

tive case series of 148 consecutive scoliosis with short time

results after 1 year compared with a historical retrospec-

tive case series of 100 consecutive scoliosis SOSORT award

2015 winner de Mauroy JC Journe A Gagaliano F Lecante

C Barral F Pourret S Scoliosis 2015 Aug 191026

SOSORT Award Winner 2015 a multicentre study comparing the

SPoRT and ART braces effectiveness according to the SO-

71

SORT-SRS recommendations Zaina F de Mauroy JC Don-

zelli S Negrini S Scoliosis 2015 Aug 111023 doi 101186

s13013-015-0049-4 eCollection 2015

Research quality in scoliosis conservative treatment state of the art

Zaina F Romano M Knott P de Mauroy JC Grivas TB Kotwicki T

Maruyama T OrsquoBrien J Rigo M Negrini S Scoliosis 2015

Jul 111021 doi 101186s13013-015-0046-7 eCollection

2015

Brace Classification Study Group (BCSG) part one - definitions and

atlas Grivas TB de Mauroy JC Wood G Rigo M Hresko

MT Kotwicki T Negrini S Scoliosis Spinal Disord 2016 Oct

311143 eCollection 2016

Physiotherapy scoliosis-specific exercises - a comprehensive review

of seven major schools Berdishevsky H Lebel VA Bettany-

Saltikov J Rigo M Lebel A Hennes A Romano M Białek

M Mrsquohango A Betts T de Mauroy JC Durmala J Scoliosis

Spinal Disord 2016 Aug 41120 doi 101186s13013-016-

0076-9 eCollection 2016 Review

Index

ABOUT THE AUTHOR

de Mauroy de Curiegravere de Castelnau Jean Claude

Medical Doctor Specialist in

- Physical and Rehabilitation Medicine

- Biomechanics of the musculoskeletal system

- Electromyography

- Osteopathy and manual medicine

- Sports Medicine

Head of Orthopaedic Medicine Department ndash Clinique du Parc

- Lyon

In 1973 Dr de Mauroy was still a medicine student at the Centre

des Massues world famous centre for scoliosis treatment He met

Dr Stagnara who entrusted him his thesis on infantile scoliosis MD

72

in 1975 he became head of a department of 36 beds for paediatric

orthopaedics

He will create with Dr Stagnara the Outpatient and Documenta-

tion department of the Centre des Massues With Dr Stagnara retir-

ing he created with his successor Dr Picault the Lyon Spine Center

at the Clinique du Parc

Dr de Mauroy a is retired lecturer at the University Claude Ber-

nard Lyon 1

- Faculty of Medicine

- Faculty of Pharmacy

- Institute of Rehabilitation

- Polytechnic Institute

Dr de Mauroy is President of the SIRER (International Society of

Spine Research) and was President of the SOSORT in 2013

He is the co-inventor of the new Lyon brace ARTbrace (2013)

(EP 2 878 284 A1)

AWARDS

SOSORT 2010 ndash award for ldquoHistorical Lyonnaise brace treatment

for adolescent hyperkyphosis Results of 272 cases reviewed 2 years

minimum after removal of the bracerdquo

SOSORT 2015 ndash award for ldquoThe short time results after 1- year of

the first 1 00 scoliosis treated with the new Lyon ARTbrace

A matched pair control with the old Lyon Bracerdquo

History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

iii

The information in this book is Open Access and could be shared with everyone if the information is freely given and the source

acknowledged No part of this book may be reproduced for profit

Copyright copy 2017 by Author Name

All rights reserved No part of this publication may be reproduced distributed or transmitted in any form or by any means including photocopying recording or other electronic or mechanical meth-ods without the prior written permission of the publisher except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law For permis-sion requests write to the publisher addressed ldquoAttention Permis-sions Coordinatorrdquo at the address below

Jean Claude de MauroyClinique du Parc155 Boulevard Stalingrad 69006 Lyon Francewwwdemauroyeu

Book Layout copy2015 BookDesignTemplatescom

Ordering InformationQuantity sales Special discounts are available on quantity purchases by corporations associations and others For details contact the ldquoSpecial Sales Departmentrdquo at the address above

Reference Manual for the ARTbrace Jean C De Mauroy mdash2nd ed 2017

Contents

History of ARTbrace 2

The interdisciplinary team approach 7

New concepts 11

Principles of ARTbrace 21

Brace prescription 32

Regional Shape Capture 36

Brace construction 41

Management of the patient with ARTBrace 51

Instructions for wearing the ARTbrace 55

Results amp discussion 59

Conclusion 65

Acknowledgments





















system















of this brace


Prolegomenon

































of learning


c h a p t e r 1

History of ARTbrace


















practiced















of the concavity

















to be




















































ISPO 2017 - Olomouc


c h a p t e r 2





established






of information



















Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

Acknowledgments





















system















of this brace


Prolegomenon

































of learning


c h a p t e r 1

History of ARTbrace


















practiced















of the concavity

















to be




















































ISPO 2017 - Olomouc


c h a p t e r 2





established






of information



















Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

Prolegomenon

































of learning


c h a p t e r 1

History of ARTbrace


















practiced















of the concavity

















to be




















































ISPO 2017 - Olomouc


c h a p t e r 2





established






of information



















Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion


c h a p t e r 1

History of ARTbrace


















practiced















of the concavity

















to be




















































ISPO 2017 - Olomouc


c h a p t e r 2





established






of information



















Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

















to be




















































ISPO 2017 - Olomouc


c h a p t e r 2





established






of information



















Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

























ISPO 2017 - Olomouc


c h a p t e r 2





established






of information



















Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion












Group


liosis bracing

2 Communication


Website

Newsletter







Palermo)







SP)





personalities

6 Climate








8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion





8 Clarity of vision



image







autonomy

The Scoliosis Team





c h a p t e r 3

New concepts







= 0















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion















Asymmetry

Background

























Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion










Aims










Scope





Background











bull Transparency



bull No bisphenol A




Aims

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

















reverse scoliosis



Scope




Torsion

Background










working together

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

19





century





pelvic belts





















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion
















c h a p t e r 4














yield

















should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion













should be creep














necessary

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

















to be strongerrdquo












tal chains




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion




































which is the spine



into a diamond

























the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion














the brace



fused spine is lost








Bangalore 2017
















ldquo




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion




















































c h a p t e r 5

Brace prescription

















phase



















Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion







Curve Location

























bracing)




Bangalore 2017



c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion


c h a p t e r 6












posite side













the polycarbonate




































case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion



















case 682

c h a p t e r 7

Brace construction























frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion




















frontal plane














torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion







torical Lyon brace




















The story of Olympe












The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion




The story of Adele
















ethylene TLSO





ADULT SCOLIOSIS


















































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion






































MANUFACTURING



Trim Lines











flat back



c h a p t e r 8











axis well balanced











the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion






the table






be more dynamic




blocks of 4 hours


more than 10deg)

--gt No Change


5deg


time every year








angle



in stature















in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion










in the future


Bangalore 2017

Lyon Method PSSE

c h a p t e r 9















elasticity













than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion











than 50









wearing


practice of sport












ion of the trunk

Body cares





with the brace

Alimentation





Sitting position







At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion


At night





ART Spirometry


ART Quality of Life

c h a p t e r 1 0


Methods

Study design









Protocol











involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion



involved

















= -339 p = 001)



cant (r = -296 p = 001)


(n=152 range -48 to 100 )

Sagittal Correction


































are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion








are female (85 )







Correlations













CONCLUSION






Discussion







treatment
























Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion









Bangalore 2017






plane

c h a p t e r 1 1

Conclusion

























hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion







hypokyphosis





















Soft Polyeth-

ylene

Polycar-

bonate

Comment


Sagittal No publi-

cation


Rotation

(apical)

+++ +++

Torsion

(Global)


upper point

A x i a l

Elongation

0 ++ +++ 18 cm



Effect ive-

ness

+ +++ ++++

Efficacy + +++ ++++




overcorrecting


instantaneous


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion


Repeatabil-

ity


moulading


Adaptation

time

1 hour +

physio


Bibliography








919

















71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

71



s13013-015-0049-4 eCollection 2015





2015











Index

ABOUT THE AUTHOR





- Electromyography


- Sports Medicine


- Lyon




72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

72


orthopaedics






nard Lyon 1








(EP 2 878 284 A1)

AWARDS







History of ARTbrace


New concepts


Brace prescription


Brace construction




Conclusion

reference manual for the artbrace 2018 - home page …demauroy.eu/pdf/art reference manual.pdf · 2...

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