NHS TLSO Assembly Instructions
5
Special considerations
If your child has a gastrostomy, a hole will be
cut out of their brace to allow for this. A small
hole will also need to be cut into their vest to
pass the feeding tube through the hole in the
brace.
If they wear nappies, their therapist will advise
as to whether you need to remove the brace
for toileting.
If your child has a moulded seat or supports
on either side of their wheelchair, their chair
will need a review with your local wheelchair
service to make sure they can wear the brace
whilst in their chair.
How do I know if my child
needs a brace?
If you can get more than two fingers
underneath the armpit at the top of the brace,
if your child’s shape has changed or the brace
is loose, then your child may need a new
brace.
Braces normally need a review every 9-12
months after the initial fitting, depending on
the amount of growth your child has had.
You do not have to wait for your spinal
appointment to book into the orthotics
clinic.
The British Scoliosis Society
w: www.britscoliosissoc.org.uk
Scoliosis Association UK
w: www.sauk.org.uk
Your comments and concerns
For advice, support or to raise a concern,
contact our Patient Advice and Liaison
Service (PALS). To make a complaint,
contact the complaints department.
t: 020 7188 8801 (PALS)
e: pals@gstt.nhs.uk
t: 020 7188 3514 (complaints)
e: complaints2@gstt.nhs.uk
Language and accessible support services
If you need an interpreter or information about
your care in a different language or format,
please get in touch.
t: 020 7188 8815
e: languagesupport@gstt.nhs.uk
Thoraco-lumbar
spinal orthosis
(TLSO)
Parents’ guide
Leaflet number: 4017/VER2
Date published: January 2019
Review date: January 2022
© 2019 Guy’s and St Thomas’ NHS Foundation Trust
A list of sources is available on request
Contact us
If you have any questions or concerns with
your child’s brace, please contact the
children’s physiotherapy team, t: 020 7188
4660, (Monday to Friday, 9am to 5pm).
For more information leaflets on conditions,
procedures, treatments and services offered
at our hospitals, please visit
w: www.evelinalondon.nhs.uk/leaflets
2
3
4
What is a TLSO spinal brace?
A TLSO spinal brace is a thermoplastic
custom made brace made to control your
child’s spinal curvature. It can be designed
to fasten down the front (one piece), or down
the sides (two piece).
Who needs to wear a spinal
brace?
Your child has been asked to wear a spinal
brace to try and control their spinal posture
and/or to slow deterioration of their curve
whilst they grow.
When does my child need to
wear their spinal brace?
Your child’s spinal consultant will inform you
how long your child needs to wear their
brace for. Usually, if your child has a
neurodisability or has growth rods, they will
need to wear the brace throughout the
daytime. It can be removed for swimming,
bathing, during therapy and at bed time.
If they have early onset or adolescent
idiopathic scoliosis, then the brace must be
worn for 23 hours a day, including in bed. It
can be removed for bathing. Research
shows those who wear the brace the
longest, have the greatest benefit.
How do I put the brace on?
The brace should be worn over a thin cotton
close fitting vest or t-shirt. Turning this inside
out can avoid rubbing from the seams. Other
clothing can then be worn over the top of the
brace to reduce pressure under it.
To apply a one piece brace
If your child is able to sit or stand on their
own
•Stretch the brace apart and wrap it around
their middle from behind, placing the
opening at the front.
•Lie your child down in the brace, with their
knees bent up. Pull the brace into the
correct position so that the waist of the
brace lines up with their waist.
•Tighten the straps firmly so that the brace
is secured around their hips, waist and
chest. Make sure the strap across the hips
is done up firmly so the brace does not
slide up.
If your child cannot sit unaided
•Sit them forward with support.
•Wrap the brace around their middle and
roll or lie down onto their back.
You should then be able perform the next
steps as in the paragraph above.
To apply a two piece spinal brace
•Put the back part of the brace onto the
bed then lie your child onto this. Make
sure their waist is lined up with the waist of
the brace.
•Lay the front half of the brace on top of
their chest. Make sure there is an equal
overlap on both sides and that the waist
lines up.
•Tighten the straps so the brace is secured
over the hips, waist and chest. Make sure
the strap across the hips is done up firmly
so the brace does not slide up.
The amount of time in the brace should be
gradually built up initially to improve your
child’s tolerance of the brace.
Skin care
You should check your child’s skin every day
after they’ve been wearing their brace. This
is particularly important if your child has any
changes in their sensation.
The brace may cause some marking or
redness, but should not cause any bruises,
blisters or pain. If red marks do not
disappear within 30 minutes of removing the
brace, then contact the physiotherapists on
020 7188 4660 to make an appointment to
review the brace.
The brace should initially be worn for a
couple of hours a day, gradually building up
until it is being worn for the prescribed time.
2
3
4
What is a TLSO spinal brace?
A TLSO spinal brace is a thermoplastic
custom made brace made to control your
child’s spinal curvature. It can be designed
to fasten down the front (one piece), or down
the sides (two piece).
Who needs to wear a spinal
brace?
Your child has been asked to wear a spinal
brace to try and control their spinal posture
and/or to slow deterioration of their curve
whilst they grow.
When does my child need to
wear their spinal brace?
Your child’s spinal consultant will inform you
how long your child needs to wear their
brace for. Usually, if your child has a
neurodisability or has growth rods, they will
need to wear the brace throughout the
daytime. It can be removed for swimming,
bathing, during therapy and at bed time.
If they have early onset or adolescent
idiopathic scoliosis, then the brace must be
worn for 23 hours a day, including in bed. It
can be removed for bathing. Research
shows those who wear the brace the
longest, have the greatest benefit.
How do I put the brace on?
The brace should be worn over a thin cotton
close fitting vest or t-shirt. Turning this inside
out can avoid rubbing from the seams. Other
clothing can then be worn over the top of the
brace to reduce pressure under it.
To apply a one piece brace
If your child is able to sit or stand on their
own:
•Stretch the brace apart and wrap it around
their middle from behind, placing the
opening at the front.
•Lie your child down in the brace, with their
knees bent up. Pull the brace into the
correct position so that the waist of the
brace lines up with their waist.
•Tighten the straps firmly so that the brace
is secured around their hips, waist and
chest. Make sure the strap across the hips
is done up firmly so the brace does not
slide up.
If your child cannot sit unaided:
•Sit them forward with support.
•Wrap the brace around their middle and
roll or lie down onto their back.
You should then be able perform the next
steps as in the paragraph above.
To apply a two piece spinal brace
•Put the back part of the brace onto the
bed then lie your child onto this. Make
sure their waist is lined up with the waist of
the brace.
•Lay the front half of the brace on top of
their chest. Make sure there is an equal
overlap on both sides and that the waist
lines up.
•Tighten the straps so the brace is secured
over the hips, waist and chest. Make sure
the strap across the hips is done up firmly
so the brace does not slide up.
The amount of time in the brace should be
gradually built up initially to improve your
child’s tolerance of the brace.
Skin care
You should check your child’s skin every day
after they’ve been wearing their brace. This
is particularly important if your child has any
changes in their sensation.
The brace may cause some marking or
redness, but should not cause any bruises,
blisters or pain. If red marks do not
disappear within 30 minutes of removing the
brace, then contact the physiotherapists on
020 7188 4660 to make an appointment to
review the brace.
The brace should initially be worn for a
couple of hours a day, gradually building up
until it is being worn for the prescribed time.
2
3
4
What is a TLSO spinal brace?
A TLSO spinal brace is a thermoplastic
custom made brace made to control your
child’s spinal curvature. It can be designed
to fasten down the front (one piece), or down
the sides (two piece).
Who needs to wear a spinal
brace?
Your child has been asked to wear a spinal
brace to try and control their spinal posture
and/or to slow deterioration of their curve
whilst they grow.
When does my child need to
wear their spinal brace?
Your child’s spinal consultant will inform you
how long your child needs to wear their
brace for. Usually, if your child has a
neurodisability or has growth rods, they will
need to wear the brace throughout the
daytime. It can be removed for swimming,
bathing, during therapy and at bed time.
If they have early onset or adolescent
idiopathic scoliosis, then the brace must be
worn for 23 hours a day, including in bed. It
can be removed for bathing. Research
shows those who wear the brace the
longest, have the greatest benefit.
How do I put the brace on?
The brace should be worn over a thin cotton
close fitting vest or t-shirt. Turning this inside
out can avoid rubbing from the seams. Other
clothing can then be worn over the top of the
brace to reduce pressure under it.
To apply a one piece brace
If your child is able to sit or stand on their
own
•Stretch the brace apart and wrap it around
their middle from behind, placing the
opening at the front.
•Lie your child down in the brace, with their
knees bent up. Pull the brace into the
correct position so that the waist of the
brace lines up with their waist.
•Tighten the straps firmly so that the brace
is secured around their hips, waist and
chest. Make sure the strap across the hips
is done up firmly so the brace does not
slide up.
If your child cannot sit unaided
•Sit them forward with support.
•Wrap the brace around their middle and
roll or lie down onto their back.
You should then be able perform the next
steps as in the paragraph above.
To apply a two piece spinal brace
•Put the back part of the brace onto the
bed then lie your child onto this. Make
sure their waist is lined up with the waist of
the brace.
•Lay the front half of the brace on top of
their chest. Make sure there is an equal
overlap on both sides and that the waist
lines up.
•Tighten the straps so the brace is secured
over the hips, waist and chest. Make sure
the strap across the hips is done up firmly
so the brace does not slide up.
The amount of time in the brace should be
gradually built up initially to improve your
child’s tolerance of the brace.
Skin care
You should check your child’s skin every day
after they’ve been wearing their brace. This
is particularly important if your child has any
changes in their sensation.
The brace may cause some marking or
redness, but should not cause any bruises,
blisters or pain. If red marks do not
disappear within 30 minutes of removing the
brace, then contact the physiotherapists on
020 7188 4660 to make an appointment to
review the brace.
The brace should initially be worn for a
couple of hours a day, gradually building up
until it is being worn for the prescribed time.
5
Special considerations
If your child has a gastrostomy, a hole will be
cut out of their brace to allow for this. A small
hole will also need to be cut into their vest to
pass the feeding tube through the hole in the
brace.
If they wear nappies, their therapist will advise
as to whether you need to remove the brace
for toileting.
If your child has a moulded seat or supports
on either side of their wheelchair, their chair
will need a review with your local wheelchair
service to make sure they can wear the brace
whilst in their chair.
How do I know if my child
needs a brace?
If you can get more than two fingers
underneath the armpit at the top of the brace,
if your child’s shape has changed or the brace
is loose, then your child may need a new
brace.
Braces normally need a review every 9-12
months after the initial fitting, depending on
the amount of growth your child has had.
You do not have to wait for your spinal
appointment to book into the orthotics
clinic.
The British Scoliosis Society
w: www.britscoliosissoc.org.uk
Scoliosis Association UK
w: www.sauk.org.uk
Your comments and concerns
For advice, support or to raise a concern,
contact our Patient Advice and Liaison
Service (PALS). To make a complaint,
contact the complaints department.
t: 020 7188 8801 (PALS)
e: pals@gstt.nhs.uk
t: 020 7188 3514 (complaints)
e: complaints2@gstt.nhs.uk
Language and accessible support services
If you need an interpreter or information about
your care in a different language or format,
please get in touch.
t: 020 7188 8815
e: languagesupport@gstt.nhs.uk
Thoraco-lumbar
spinal orthosis
(TLSO)
Parents’ guide
Leaflet number: 4017/VER2
Date published: January 2019
Review date: January 2022
© 2019 Guy’s and St Thomas’ NHS Foundation Trust
A list of sources is available on request
Contact us
If you have any questions or concerns with
your child’s brace, please contact the
children’s physiotherapy team, t: 020 7188
4660, (Monday to Friday, 9am to 5pm).
For more information leaflets on conditions,
procedures, treatments and services offered
at our hospitals, please visit
w: www.evelinalondon.nhs.uk/leaflets
Table of contents
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