Lesson 1Materials and measurement: sizing TLSO, pads, straps, donning aids, clothing considerationsExplains measurements and materials for brace sizing, like torso length and girth, pad and strap choices, donning tools, and clothing, to provide support while guarding 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 physiotherapyOutlines follow-up post-bracing, including pain and function reviews, x-ray checks, bone health assessments, slow brace reduction, and referrals for osteoporosis care and targeted physio.
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 precautionsProvides key education for patients and caregivers on brace use, covering putting on/removing, wear times, avoided activities, safe moves, bending cautions, and daily routine integration.
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 adultsExamines vertebral compression fracture causes, osteopenia and osteoporosis roles in bone weakening, and functional effects on older adults, informing immobilisation and rehab strategies.
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 braceLists urgent review signs in braced patients, such as growing weakness, bowel/bladder shifts, sensory loss, or worsening pain, with triage and prompt communication methods.
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 pre-bracing assessments for safety, including skin checks, breathing status, mobility baseline, cognition, and red flags to ensure brace tolerance and correct use in 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 needsGuides choosing semi-rigid TLSO or Jewett for stable L2 fractures, factoring fracture type, osteopenia level, posture, balance, and activity needs for optimal safety and comfort.
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 goals of spinal support for stable L2 fractures, like pain relief, flexion control, and daily activity protection while keeping mobility to avoid deconditioning in seniors.
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 thoracolumbar supports for stable L2 fractures, comparing TLSO types, Jewett braces, and soft corsets, focusing on indications, contraindications, and mechanics for 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 assessmentCovers post-fitting checks for safety, including comfort, breathing issues, sit-to-stand ability, and pressure spots, enabling quick adjustments to avoid problems and boost compliance.
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 flexionOffers step-by-step fitting for TLSO or Jewett braces, emphasising spine alignment, pad spots, strap tightness, flexion relief, and checks for comfort and caregiver consistency.
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
