Abstract

1
Three-Segment Thoraco Lumbar Sacral Orthotic
BraceD. Hower, A. Ravindra, J. Schaberl, K.
Zawrotny

• Abstract
• Thoraco Lumbar Sacral Orthotic (TLSO) braces are
  used to immobilize the spine following injuries
  or surgical procedures. Current bi-valve brace
  designs are difficult to place, which often leads
  to improper placement procedures and ill fit. A
  Three-Segment TLSO brace was designed to counter
  these problems while providing the same level of
  support. A prototype was constructed, and
  verified with orthotics specialist and
  self-placement tests. The results indicate that
  the Three-Segment brace was faster to place, with
  less required movement than the bi-valve design.
  The design was further validated by approval from
  orthotics and rehabilitation specialists. In
  conclusion, the Three-Segment brace offers a
  viable alternative to current bi-valve designs.

Results Results of the orthotics specialist test
can be found in Table 1. The average time
required for the orthotics specialist to place
the bi-valve brace was 89.3s. The average time
required for the orthotics specialist to place
the Three-Segment brace was 45s. Results of the
self-placement test can be found in Table 2. The
average time for placement of the bi-valve brace
was 117s, with 2.8 log rolls required. The
average time for placement of the Three-Segment
brace was 99s, with 1.5 log rolls required.
Table 1 Results of Orthotics Specialist Test
Table 2 Results of Self-Placement Tests
Brace Type Trial Time (sec)
Bi-Valve 1  83
Bi-Valve 2 105 
Bi-Valve 3 80 
Three-Segment 1 40 
Three-Segment 2 45 
Three-Segment 3 50 
Brace Type Trial Time (sec) Number Rolls
Bi-Valve 1 130 3.5
Bi-Valve 2 111 2.5
Bi-Valve 3 109 2.5
Three-Segment 1 103 1.5
Three-Segment 2 99 1.5
Three-Segment 3 95 1.5
Introduction Many people require the use of a
thoracic lumbar sacral orthotic (TLSO) brace to
fully recover from either a spinal injury such as
compression or burst fractures, or surgical
procedures such as spinal fusions,
decompressions, and treatment for ankylosing
spondylitis. Proper use of the TLSO brace will
inhibit bending and twisting of the upper body,
which allows the spinal cord to heal in an
acceptable amount of time. Currently, the
bi-valve TLSO brace (Figure 1) is the most
commonly used design. Since it is difficult to
put on correctly, improper placement procedures
are often followed, leading to ill-fit of the
brace. The difficulty with bi-valve brace
placement is largely the result of the single,
rigid back segment. This piece must be slid
underneath the patient while they lie on their
side an often painful and extremely difficult
process for patients lacking assistance. In
order to avoid this discomfort, patients often
sit or stand to put on the TLSO brace, which adds
load to the spine. This can cause more pain to
the patient, and prevent the brace from fitting
correctly. The project objective was to redesign
the TLSO brace to improve ease and speed of
correct placement. The new brace should provide
the same level of support afforded by a bi-valve
brace, and should not introduce significantly
higher costs to the customer.
Discussion The results indicate that the
Three-Segment TLSO brace can be placed faster
than the bi-valve brace. This was true in the
orthotics specialist test as well as the
self-placement test. It is especially
significant that the Orthotics Specialist, with
25 years of experience placing bi-valve braces,
was able to place the Three-Segment brace in half
the time. The faster times indicate that the
Three-Segment TLSO brace is more easily placed
than a bi-valve brace, for both healthcare
professionals and patients. Further, the
self-placement test demonstrates that less
rolling is required to place the Three-Segment
TLSO brace. Less movement is desirable as it
reduces pain caused to the patient during
placement. Therefore, improper placement
procedures are less likely to be followed. The
design of the Three-Segment TLSO brace was
validated through consultation with
Rehabilitation and Orthotics Specialists. Both
professionals claimed to feel comfortable in
prescribing the new design to patients with back
injuries.
Materials and Methods Design Development
Consultation with Orthotics and Rehabilitation
Specialists were used to guide the design of the
Three-Segment TLSO brace (Figure 2). This design
features split back segments, which do not
require any portion of the brace to be slid under
the patient. The back segments are connected to
the front piece by hinges, allowing for easier
manipulation of the brace. The brace is fastened
by three non-Velcro straps, which allow for a
faster connection process. Prototype
Fabrication A mold of a test subject was
fabricated by applying several layers of wet
plaster bandages around the torso, and allowing
them to dry. This plaster cast was then removed
and filled with molding plaster to obtain a
positive mold. Plastic was vacuum-folded around
the mold. Finally, AliPlast was applied to the
inside of the brace. Additional steps were taken
to add hinges and straps to complete the
brace. Testing Procedures The first test
conducted with the three-segment TLSO brace was a
timed trial of brace placement performed by an
orthotics specialist. Hanger Orthopedic Group
staff members with experience in putting on TLSO
braces were timed while placing the original
bi-valve brace and the Three-Segment brace on the
test subject three times. The second test
compared the ability of the test subject to place
the bi-valve brace versus the Three-Segment brace
without assistance. Both time and rolling
requirements were quantified in this test.
Figure 1 The bi-valve TLSO brace
Figure 2 The three-segment TLSO brace
Caption 1 A picture of the bi-valve TLSO brace
Caption 2 A picture of the three-segment TLSO
brace
Acknowledgments Thanks to the generous gift of
Drs. Hal Wrigley and Linda Baker, the
BioEngineering Department, Bob Mawhinney and the
Hanger Orthopedic Group Staff, Dr. Boninger, Dr.
Fulay, and Andy Holmes