Lesson 1Materials and measurement: sizing TLSO, pads, straps, donning aids, clothing considerationsThis lesson covers measurements and materials for accurate brace sizing, including torso length and width, pad and strap choice, donning aids, and clothing layers, to provide effective support while protecting sensitive 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 physiotherapyThis lesson describes structured follow-up after bracing, including pain and function checks, x-ray review, bone health assessment, gradual brace removal, and timely referral for osteoporosis care 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 precautionsThis lesson details essential education for patients and caregivers on brace use, including putting on and removing, wearing times, restricted activities, safe transfers, bending precautions, and ways to fit the brace into daily life.
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 adultsThis lesson explores how vertebral compression fractures happen, the role of osteopenia and osteoporosis in weakening bones, and specific functional effects on older people, guiding immobilization and rehabilitation plans.
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 braceThis lesson defines warning signs needing urgent review in braced patients, such as new weakness, bowel or bladder changes, numbness, or worsening pain, and explains triage and quick communication of these issues.
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 instructionsThis lesson details pre-bracing assessment for safe immobilization, including skin check, breathing status, baseline mobility, mental ability, and red flags, ensuring the orthosis is suitable and used correctly by older adults.
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 needsThis lesson explains selecting between semi-rigid TLSO and Jewett braces for stable L2 fractures, considering fracture type, osteopenia level, posture, balance, and daily activities to optimize safety, comfort, and use.
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 mobilityThis lesson clarifies aims of external spinal support in stable L2 fractures, focusing on pain relief, motion control, and protection in daily activities while keeping safe mobility and reducing weakness 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 mechanicsThis lesson reviews thoracolumbar supports for stable L2 fractures, comparing TLSO types, Jewett hyperextension braces, and soft lumbar corsets, emphasizing indications, contraindications, and how they work 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 assessmentThis lesson outlines immediate post-fitting checks for safety and tolerance, including comfort, breathing function, sit-to-stand ability, and pressure points, allowing quick adjustments to avoid problems and non-use.
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 flexionThis lesson provides a step-by-step guide to fitting TLSO or Jewett braces, stressing spinal alignment, pad positioning, strap tension, and flexion relief, with ways to check comfort, safety, and consistent use by 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
