Sunday, May 29, 2022

Re: TLSO for infant

Paula Pivko

Thank you all for the many responses on my inquiry about fitting an 18 month old with a TLSO. Many people suggested Benik, Spinal Tech, and SureStep. Because of the insurance involved we kept this inhouse. There was a suggestion of casting around a doll which I was able to do. Then I did a check fit on the child. It is a shame we can’t bill for check fits in orthotics but I still find them very useful when there is severe deformities or other complications. Orthoplast and other low heat mold plastics worked well for a check fit. Ended up doing a thin polyethylene anterior opening TLSO which worked well in improving head control and hopefully will help him gain better hand eye coordination. It gets very hot in Florida so aliplast was done only over bony ridges. Soft aliplast and pelite tongue in the front so he could breathe and there was no compression on his stomach. He has no feeding issues. Here are some other responses. Thank you to all who responded!

Paula Martinek LPO

We have made several of these in our office, I like the soft approach myself while some of my colleagues prefer using MPE. I pull aliplast first (closest to the skin) then a medium density pelite. Last i pull a 1/16″ kydex frame. I can control the shape of the frame to get the support where it is needed the most…Both are anterior openings for ease in donning and doffing…plus it is easy for a G-tube cut out….Good luck…

I’ve done a few TLSO for SMA kids with mixed experiences. The one closest to the age of your kiddo did not tolerate the pressure on her abdomen due to feeding issues. The other child who did not have feeding issues tolerated the TLSO well. We used a thin PE, fully lined, anterior opening TLSO.

I have done circumferential wraps on these little ones with someone providing “thoracic suspension” for the wrap and then laying the kid supine and getting the pelvic tilt you want. I use a cut off strip anterior mid-line.
I’ve also done direct formed 1/2″ plastazote (overlap in the front) with two wrap around straps. You need to really mold in the waist; double stockinette and watch the zote isn’t too hot.

You may want to consider molding a TLSO out of 3D-Lite from Allard. It’s totally breathable and therefore won’t create any core temperature issues on a kiddie who will spend a lot of time it the device. It’s available 3, 5 and 7mm thickness. For someone that small I’m sure the 5mm would do great.
Safe and effective. Pretty good combination.

It’s not uncommon for us to use a soft body jacket with internal struts and then a wide open abdominal area due to being weak/belly breathers–hold onto the ribs, but then wide open for the belly area, and hold on to the pelvis/ASIS anteriorly and make sure the superior trimline hits just underneath the clavicles (dip down for the sternal notch/trachea) and to spine of scap posteriorly. The anterior opening can really depends on how well they breathe and if they have flared ribs –sometimes ask the MD or PT if you need to clarify; but I do agree with the single piece TLSO with anterior open. For those who need even more support, sometimes switching over to an external frame with a good mold and similar trimlines discussed.

Hi Paula
The TLSO will give the child better postural control and will help improve head control. Also over the past 30 years of working with peds I have found posterior opening TLSO’s arer much easier for families and care givers to don. I use a soft TLSO design with an external frame of 1/8″ modified polyethylene.

You can fit this child with direct molded Plastazote. Just warm, wrap around the child, trim and add straps.

This child has impaired respiratory capability. A TLSO will likely negatively impact respiration. A custom seating device is clearly the best solution. You will have to include capability for posterior tilt in your system.

I do a lot of spinal bracing for SMA. Sure step makes a nice tlso. I often couple with a henslinger collar or take apart a Minerva ctlso to provide head support

I dealt with this issue multiple times and what worked the best was a rigid posterior panel with c-fold strapping in a H pattern. Make sure not to limit abdominal distention. We tend to believe that restrictions over the chest would decrease pulmonary function but SMA is different. Abdominal distention actually is used to fill the lungs and not chest expansion as these muscles are weakened. Caution !! Wrap around type tlso’s on this type of patient can have severe consequences.

Please look into the SPIO TLSO. We have used several the past year with toddlers with great success. Most don’t even mind wearing it. It is ideal for those with Hypotonia, Cerebral Palsy, Down Syndrome, Muscular Atrophy, Athetosis, and Sensory Processing Disorder. They have a soft compression version and a more ridgid version. Great customer support and fast shipping. Not sure how small they go, but they do custom measurements too.

I know this is strange answer, but I would recommend having the PT try the child out with a foam lifejacket (link below) to see if this is helpful at all for him. It will approximate the support of a soft TLSO without committing to any particular design.

I’ve casted many children this young. Have one person, can even be family, hold under head/shoulders and other hold under butt/legs. Suspend and curcumferentially wrap with cut strip anteriorly. I would fit with one piece TLSO

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