PDA

View Full Version : TLSO brace, does it work?



gerbo
06-27-2006, 11:29 AM
Does anybody know of any evidence or research, showing that a TLSO brace i.e the one which fits the body thightly, hand in glove, and made from a plastercast (so I am not talking about a Boston brace), makes any difference in the natural history of scoliosis?

I haven't come across any..........

LindaRacine
06-27-2006, 11:52 AM
Gerbo...

The Boston Brace IS a TLSO. Some specialists use an off the shelf version while others use a custom made brace.

--Linda

gerbo
06-27-2006, 12:01 PM
just to clarify, to me the boston brace is a very specific type of brace which works with padding/ pressure on one side and expansion space on the other side. They are made from off the shelf modules and correction can be adjusted after the initial fitting (by adding extra padding on certain pressure points

In the UK the TLSO which is used a lot is different in that it is made to fit the body exactly, without any padding, pressure points or expansionspaces. It literary fits hand in glove as it is made after a body/ plastercast specific for that patient. The only correction it provides is the correction induced during the application of the plaster, following fitting no further correction can be given.

I know that people call any tlso a boston brace, but that is incorrect, although a boston is an example of a tlso, but one with quite a specific action, and one where most of the research seems to be based on.

does that make sense?

maybe in the USA only real bostons are used and the question isn't really relevant

desheah
06-27-2006, 12:08 PM
this is not exactly what you are looking for, but it is interesting:

Prosthet Orthot Int. 2003 Aug;27(2):121-31. Links

Effect of different casting methods on adolescent idiopathic scoliosis.

* Wong MS,
* Lee JT,
* Luk KD,
* Chan LC.

The Hong Kong Polytechnic University, Rehabilitation Engineering Centre, Kowloon, Hong Kong, China. rcmswong@polyu.edu.hk

Scoliosis is a three-dimensional spinal deformity. Although orthotic treatment for moderate adolescent idiopathic scoliosis (AIS) has been well recognized, there are few studies documenting the effectiveness of different casting methods in the fabrication of thoracolumbo-sacral orthoses (TLSO). The current study was a retrospective clinical evaluation of the effectiveness of two commonly used casting methods namely, the frame casting method and the supine with traction casting method in the treatment of AIS. Eighty (80) female patients with AIS were recruited and they were all treated by TLSOs. The frame casting method was used in 37 patients while the remaining 43 patients were under the supine with traction casting method. The responses of spinal deformities under the two different casting methods were analyzed for the period from pre-brace to 2 years after bracing. The studied parameters included the AP Cobb's angle, the apical vertebral rotation and the trunk listing (cervico-sacral lateral offset). The results of the current study showed that the orthoses manufactured from the two casting methods could provide an effective control of AIS (change of Cobb's angle within (+/- 5 degrees). For the frame casting, the Cobb's angles at pre-brace and 2 years after off-brace were 36.0 degrees and 33.8 degrees respectively while for the supine with traction casting, the corresponding Cobb's angles were 32.7 degrees and 34.0 degrees. The frame casting method could give a better control of the apical vertebral rotation at the early stage of treatment (pre-brace = 18.2 degrees and the 4th month = 13.8 degrees while the supine with traction casting method was more effective in the long-term control of the trunk listing (pre-brace = 10mm and 2 years after off-brace = 3.3mm).

PMID: 14571942 [PubMed - indexed for MEDLINE]

deshea

LindaRacine
06-27-2006, 12:16 PM
Gerbo...

You're right. Many U.S. specialists incorrectly use the terms interchangeably.

There have been some TLSO specific studies:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16087554&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=9836354&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=7745089&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=7334090&query_hl=1&itool=pubmed_docsum

--Linda

gerbo
06-27-2006, 12:39 PM
thanks for finding these linda

article descibes the cheneau brace, which works similar to the boston, 2nd and 3rd isn't clear what type of tlso they use. 4th does seem to describe what i am after, what is remarkable is the very high initial correction achieved.

Still, one article form 1981, not a lot to go on to decide whether these type of tlso's are effective or not.

gerbo
06-27-2006, 12:44 PM
this is not exactly what you are looking for, but it is interesting:

Prosthet Orthot Int. 2003 Aug;27(2):121-31. Links

Effect of different casting methods on adolescent idiopathic scoliosis.

gives some indication i suppose, thanks

LindaRacine
06-27-2006, 01:12 PM
Gerbo...

If anything, it would seem to me that a custom TLSO would be more effective than a Boston brace (which has a well published effectiveness rate). I think it's probably difficult to evaluate the effectiveness of custom TLSOs, in that they can vary considerably from center to center.

Regards,
Linda