Lesson 1Materials and measurement: sizing TLSO, pads, straps, donning aids, clothing considerationsCovers measurements and materials needed for accurate brace sizing, including torso length and girth, pad and strap selection, donning aids, and clothing layers, to ensure effective support while protecting fragile older skin.
Landmarks for torso length measurementChest, waist, and hip circumference sizingSelecting pads, liners, and strap typesUse of donning aids and reach toolsClothing layers to protect fragile skinDocumentation of brace size and componentsLesson 2Follow-up plan: pain and function reassessment, bone health evaluation, gradual weaning from brace, referral for bone density management and physiotherapyDescribes structured follow-up after bracing, including pain and function reassessment, radiographic review, bone health evaluation, gradual brace weaning, and timely referral for osteoporosis management and targeted physiotherapy.
Scheduled pain and function reassessmentsImaging to confirm fracture stabilityPlanning gradual reduction of brace timeScreening and labs for bone healthReferral for osteoporosis treatmentPhysiotherapy for posture and strengthLesson 3Patient education: donning/doffing, wearing schedule, activities to avoid, safe transfers and bending precautionsDetails essential patient and caregiver education for brace use, including donning and doffing, wearing schedule, restricted activities, safe transfers, bending precautions, and strategies to integrate the brace into daily routines.
Stepwise donning and doffing techniquesRecommended daily wearing scheduleActivities and postures to avoidSafe transfers, bed mobility, and gaitBending, lifting, and twisting precautionsWritten instructions and teach‑backLesson 4Vertebral compression fracture pathophysiology, osteopenia/osteoporosis influence, and functional impact in older adultsExplores how vertebral compression fractures develop, the role of osteopenia and osteoporosis in weakening bone, and the specific functional consequences for older adults, guiding appropriate immobilisation and rehabilitation planning.
Mechanisms of vertebral body compression at L2Effects of flexion and axial load on weakened boneOsteopenia versus osteoporosis at the spinePain generators in compression fracturesFunctional limitations in older adultsRisk of progression and adjacent level fracturesLesson 5Warning signs for urgent review: progressive weakness, bowel/bladder changes, new numbness, increased pain despite braceDefines warning signs that require urgent clinical review in braced patients, such as new weakness, bowel or bladder changes, sensory loss, or escalating pain, and explains how to triage and communicate these concerns promptly.
New or progressive limb weaknessBowel or bladder dysfunction onsetNew numbness or saddle anesthesiaRapidly increasing or unrelenting painSkin breakdown or brace‑related woundsWhen and how to seek urgent careLesson 6Assessment before bracing: skin inspection, respiratory status, mobility baseline, cognitive ability to follow instructionsDetails the pre-bracing assessment required for safe immobilisation, including skin integrity, respiratory status, baseline mobility, cognition, and red flags, ensuring the chosen orthosis is tolerated and used correctly by the older adult.
Skin inspection over bony prominencesRespiratory status and pulmonary reserveBaseline mobility and transfer abilityCognitive status and ability to learn tasksPain level and analgesia optimizationScreening for neurological red flagsLesson 7Brace selection for L2 stable fractures: semi-rigid TLSO vs Jewett — selection criteria considering osteopenia and activity needsExplains how to select between semi-rigid TLSO and Jewett braces for stable L2 fractures, considering fracture morphology, osteopenia severity, posture, balance, and daily activity needs to optimise safety, comfort, and adherence.
Radiographic features guiding brace choiceImpact of osteopenia and kyphosis on fitActivity level and balance considerationsAbdominal shape and respiratory factorsFall risk and need for donning assistanceShared decision‑making with patientLesson 8Objectives of external spinal support: pain reduction, motion limitation in flexion, protection during ADLs while preserving mobilityClarifies the therapeutic aims of external spinal support in stable L2 fractures, focusing on pain relief, motion control, and protection during daily activities while preserving safe mobility and minimising deconditioning in older adults.
Pain reduction through controlled immobilizationLimiting flexion and micro‑motion at L2Protecting the fracture during ADLs and transfersMaintaining safe mobility and balancePreventing deconditioning and muscle wastingSetting realistic goals with patient and familyLesson 9Types of thoracolumbar supports: thoracolumbar sacral orthosis (TLSO) varieties, Jewett hyperextension brace, soft lumbar corset — indications and comparative mechanicsReviews available thoracolumbar supports for stable L2 fractures, comparing TLSO variants, Jewett hyperextension braces, and soft lumbar corsets, with emphasis on indications, contraindications, and biomechanical action in older adults.
Rigid and semi‑rigid TLSO designsJewett hyperextension brace mechanicsSoft lumbar corset roles and limitsIndications by fracture pattern and levelContraindications in frail older adultsComparing flexion control and comfortLesson 10Immediate checks: comfort, respiratory compromise, ability to perform sit-to-stand, pressure point assessmentOutlines immediate post-fitting checks to confirm safety and tolerance, including comfort, respiratory function, sit-to-stand ability, and pressure point inspection, allowing prompt adjustment to prevent complications and nonadherence.
Pain and overall comfort reassessmentRespiratory effort and chest expansionSit‑to‑stand and short walk testingInspection of high‑risk pressure areasAdjusting straps and pads after testingCriteria for safe discharge with braceLesson 11Step-by-step TLSO or Jewett fitting and adjustment: proper alignment, pad placement, strap tensioning, unloading flexionProvides a stepwise guide to fitting TLSO or Jewett braces, emphasising spinal alignment, pad positioning, strap tension, and flexion unloading, with strategies to verify comfort, safety, and consistent application across caregivers.
Safe log‑roll and initial brace positioningAligning sternal, pelvic, and lateral padsProgressive strap tightening and rechecksEnsuring flexion unloading at L2Verifying fit in supine, sitting, standingCaregiver training for consistent fitting
