Underarm Orthosis (TLSO)
Starting brace wear | Skin care | Cleaning the brace l Clothing l Exercises l When to call the doctor | Contact us
The underarm orthosis stabilizes and prevents the progression of a spinal deformity. The time frame the brace will need to be worn will be outlined by your child's physician.
Starting brace wear
Stage I
- Apply the brace properly and wear it for two hours. Take it off and check the skin for redness and irritation. Follow skin care instructions and apply rubbing alcohol with friction, rubbing gently back and forth.
- If the skin is red and sore, keep your child's brace off for a half-hour, and then put it back on for two more hours. Once the irritation is resolved, put the brace on for another two hours. You, or whoever is helping with the brace, and your child must be able to judge when the skin can tolerate having the brace back on.
- After two hours, remove the brace and check the skin again. Give skin care. Put the brace on again if the skin will tolerate it for two more hours.
- After two hours, remove the brace and give skin care.
Stage II
If the brace was tolerated the first day, put the brace on after your child's morning bath. Remove it after four hours to check the skin and follow skin care instructions. If the skin will tolerate it, put the brace back on until suppertime. Remove it, check the skin and leave the brace off until bedtime. Put the brace back on at bedtime. It should be worn all night, without checking it, unless your child complains.
Stage III
When the brace can be worn as described in Stage II, it should be worn all day and all night - except for one hour (usually before bedtime). Your child's skin should be checked and skin care instructions should be followed every four hours during the day, if possible, or three times a day: when you get up in the morning, at mid-afternoon (after school) and at bedtime. During the one hour out of the brace, exercises should be done.
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Skin care
It is very important to prevent skin breakdown - sore, red, raw skin. The skin under the brace needs to be toughened up, especially where the brace presses hard.
To protect the skin:
- Bathe daily (bath or shower)
- Apply rubbing alcohol with friction to all parts of the skin that are pink and the areas where the brace presses a lot
- Always wear a 100 percent cotton (not blended cotton or synthetic material) undershirt, tubular knit without side seams
- Frequently check the skin for pink areas when the brace is first used
Do not use cream, lotion or powder under the brace.
If there is skin breakdown (sore, red, raw skin) the brace must not be reapplied until the skin heals – one day or more. Sometimes the skin over the waist and hips get darker. That is common and is not a problem. When the brace treatment is over, this color will go away.
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Cleaning the brace
The hard plastic outer shell and the inner soft foam plastic should be cleaned every time you bathe.
A cloth with soap and water can be used to clean the lining, followed by a damp rinsing cloth. A terry towel can help dry the foam plastic. If the lining is damp, a very cool hair dryer can be used. The outer plastic can tolerate rough cleaning.
The plastic brace should not be left in the hot sun or near a warm radiator because the plastic may soften and get out of shape.
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Clothing
As a rule, loose fitting clothes will not reveal the outline of your child's brace. For girls, smocks and peasant blouses are easier to wear. Pants usually will need to be at least one size larger. Pants with elastic waistbands may fit more easily.
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Exercises
There are two sets of exercises that your child will be given:
- The first set of exercises should be completed during the hours that your child is not wearing the brace. These exercises keep your child's back limber and the muscles from getting weak.
- The second set of exercises should be done while your child is wearing the brace. Have your child complete them as many times as possible during the day. These exercises will help the brace to be more effective in the treatment of your child's scoliosis.
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When to call the doctor
- If numbness, stinging or burning places occur under the brace
- A different, foul (bad) smell comes from the brace
- Pain occurs that is steady or increases, and is not relieved by medicine or a change in position
- The brace cracks
- When a problem occurs that prevents your child from wearing the brace for the amount of time recommended by your doctor
If you need to reach the Orthopaedic Nurse before 4 pm, Monday through Friday, please call 513-636-4567. After 4 pm, and during weekends and holidays, please call 513-636-4200 and ask that the Orthopaedic Resident on call be paged.
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Contact us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
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Rev. 7/07
