Thoracolumbosacral Orthosis (TLSO)

Transcription

1 Patient information leaflet Royal Surrey County Hospital NHS Foundation Trust Thoracolumbosacral Orthosis (TLSO) Physiotherapy Department

2 Name of patient: Date: Name of Physiotherapist: Telephone: This booklet is an adjunct to the TLSO training that has been provided to you and your carer during your hospital admission. It is not specific to a particular injury. Should you have any concerns that are not addressed within this booklet, please contact your ward Physiotherapist the contact number can be found on the back of the booklet. 2

3 What is a TLSO? TLSO stands for Thoracolumbosacral Orthosis this means that it provides stability to the upper, middle and lower sections of your back. It has two parts a front section and a back section (see pictures below). It is used to support and stabilise your back whilst healing occurs. Hence, a tight fit is vital. Front section: Metal loop A Back section: Metal loop B Shoulder straps Trunk straps 3

4 How do I put the TLSO on? Good communication is needed between both of you to ensure that a good fit is achieved. Patient Lie on your back, on a flat bed make sure that you re in a straight line and that you have a loose fitting t-shirt on (refer to the washing and dressing section in this booklet for advice for how to put t-shirt on). Bend your knees so that both your feet are flat on the bed. Reach your arm across your body towards the direction you intend to roll. As you roll, try to keep your shoulders, hips and knees in a line with your knees and heels together. This will avoid twisting your spine. 4

5 Carer Stand facing the patient s back. With one hand, push the mattress down away from the patient s body. With your other hand, feed the back section of the TLSO underneath the patient s side until the middle of it lies over the spine or as far as you can (move the TLSO against the mattress, not the patient s body). The top of it should line up with the middle of their shoulder blades and the base should line up with the top of their bottom. 5

6 Patient Roll over onto your other side using method described above Carer Move to the opposite side of the bed so you are facing the patient s back again. Check if the back section of the TLSO is in the correct position. If it is not, push the mattress down with one hand and use your other hand to gently pull the side of the TLSO through to ensure it lines up correctly with the spine. Please remember, if the TLSO needs to move up or down the back, you can only do this if the patient is lying on their side, whilst you push down on the mattress. Patient Roll onto your back. Carer Check that the back of the TLSO is in the correct position. There should be equal amounts of the back section visible on both sides of the patient. The top of each side should be level with each other, as should the bottom of each side. If this is not the case, the patient will need to roll onto their side again so you can re-adjust the TLSO as needed. Position the front section of the TLSO against the patient s stomach (as shown in picture). 6

7 Patient Hold front section of TLSO in place so that your carer can do up the straps. Carer Feed all the trunk straps through the metal loops (A) on the front section of the TLSO. Tighten up the middle straps first on each side so that the straps are pulled tight equally. Tighten the top two and then the bottom two straps equally. Adjust tightness of straps as previously advised by the Physiotherapist. The front section of the TLSO should remain in a central position over the patient s stomach once all straps have been tightened. Patient Roll onto your right side using the same technique as outlined previously and rest upper arm on your side. Carer Face the patient s back again. Feed the left shoulder strap over the patient s left shoulder and under their left arm. 7

8 Feed the shoulder strap through the metal loop (B) and tighten as previously advised by the Physiotherapist. A better fit will be achieved if the patient rests their arm on their side, whilst you tighten the strap. Patient Roll onto your left side. Carer Fasten the right shoulder strap (as described immediately above in the carer s instructions). Patient Sit up on the edge of the bed. Carer Stand behind the patient. Tighten shoulder straps as previously advised by the physiotherapist. Check that the TLSO is in the correct position. 8

9 Final check This is how the TLSO should look when it is on correctly: If the brace does not look like this, the patient will need to lie back down again and the shoulder straps undone. The front section will need to be removed and then the back section can be adjusted as required following the instructions above. 9

10 How do I take the TLSO off? Patient: Roll onto your side, on a flat bed. Carer: Undo the upper shoulder strap through metal loop B. Patient: Roll onto your other side. Carer: Undo the other shoulder strap through metal loop B. Patient: Roll onto your back. Make sure that you are lying in a straight line. Carer: Undo the trunk straps through metal loops A and remove the front section. Patient: Roll onto your side as previously described. Carer: Stand facing the patient s back. With one hand push the mattress down away from the patient s body (as pictured in the instructions to put TLSO on) and carefully remove the back section of the TLSO with the other hand, ensuring that the patient does not assist in any way. Patient: Roll onto your back using the same method as described above. You are unable to mobilise or sit up in bed now that the TLSO has been removed. You should remain in bed, lying flat until you have the TLSO back on. 10

11 How do I take care of the TLSO? Do not get the TLSO wet do not shower or bathe in it. The only part of the TLSO that can be removed is the liner of the back section. This should only be removed if it needs cleaning. In this incidence it can be either wiped clean or machine washed at a low temperature and then left to dry flat. Do not dry it on a radiator as this will make the liner shrink & curl, thus affecting the fit of the TLSO. The liner must be completely dry and re-attached to the brace before the TLSO is put back on the patient. In the unlikely event of the TLSO breaking, please contact the ward physiotherapist as soon as possible for further advice. Skin care You and your carer should monitor the skin on your back, stomach, under your arms and the tops of your shoulders for any signs of redness that do not fade shortly after the TLSO is removed. Please consult with your GP if the skin is breaking down or you are aware of any sore areas where the brace has been in contact with the skin. Washing and dressing advice You will need assistance from a family member or carer to wash and dress. As you are unable to get the TLSO wet, you will not be able to have a bath or shower. You will need to be assisted to have a strip-wash whilst lying down on a flat bed, unless previously advised otherwise by your Doctor or Therapist. You will need to be lying on your back on a flat bed with the TLSO off. You can wash the front of your upper body independently, but you must not twist whilst doing this. You will need assistance from your carer with any areas that you can not reach without twisting. You will need to roll onto your side (as previously described in the section How do I put the TLSO on ) to allow your carer to wash and dry your back. 11

12 Before putting on your TLSO your carer will need to assist you to put on a loose-fitting cotton t-shirt (it will absorb perspiration, protect your skin and keep your TLSO clean). To do this, you need to be lying on your side. Put your uppermost arm & head into the t-shirt. Your carer can pull the t-shirt down as far as possible whilst you are still lying on your side. You need to roll onto your other side so that you can put your other arm into the t-shirt. Your carer will then need to pull it down. You will need to put your TLSO on before sitting up (as described previously). Once sitting with the TLSO on, you can wash your lower legs and feet with the use of long-handled aids. You should use a long-handled reacher to put on & take off trousers, skirt and underwear, so as to avoid bending down to reach your feet. Alternatively, your carer could assist you with this. You should use a long-handled shoehorn to put on and take off your shoes. Washing your hair You will need to have your TLSO on and have some assistance from your carer. Lean forwards onto a basin, bending at the knees and hips (not the waist). You or your carer can carefully pour water over your hair using a jug. Carrying Avoid lifting until advised otherwise by your Consultant or Physiotherapist. Spread the load equally do not carry everything in one hand. 12

13 Pacing of activities Try to do things little and often with regular rests in between. Prioritise your tasks and activities know your limitations and delegate to others appropriately. Build up activity levels slowly. Driving You need to liaise with your Consultant as to when you can resume driving. You can travel as a passenger in a car as long as you can sit comfortably for the length of the journey. If you are going on a long journey you would be advised to have regular stops. When travelling in a car ensure that the seat is as far back as possible before you get in. This will increase the space in the passenger footwell and make it easier to get in and out. You can recline the back of the seat as required for comfort. Things to avoid Avoid twisting and stooping. Avoid lying on your stomach. Avoid lifting heavy objects whilst you are still needing to use the brace. Avoid low and unsupportive chairs. 13

14 Points to remember Do not loosen the TLSO when wearing it it needs to be tight to maintain the stability of your spine. Discomfort is normal. Continue to wear your TLSO as instructed by the Doctors and Physiotherapists on the ward until advised otherwise by your Consultant. If you develop any significant pain, pins and needles or numbness, you should go to A&E. In the unlikely event of the TLSO breaking, please contact the ward physiotherapist as soon as possible for further advice. Additional comments 14

15 Key reference TalarMade Limited Springwood House Foxwood Way Chesterfield S41 9RN Telephone: Compiled by Sarah Mitchell, Cassie Rowley, Kate Galloway & Debbie Gray 15

16 Contact details For further information, please do not hesitate to contact physiotherapy. Physiotherapy Services Royal Surrey County Hospital NHS Foundation Trust Egerton Road, Guildford, Surrey GU2 7XX. Telephone: Royal Surrey County Hospital (RSCH) NHS Foundation Trust fully subscribes to the National Patient Safety Agency (NPSA) Being Open best practice framework, November PALS and Advocacy contact details Contact details of independent advocacy services can be provided by our Patient Advice and Liaison Service (PALS) who are located in far left corner as you enter the main reception area. PALS are also your first point of contact for health related issues, questions or concerns surrounding RSCH patient services. Telephone: Opening hours: 9.00am 4.00pm, Monday to Friday If you would like information documents in large print, on tape or in another language or form please contact PALS. Review date: July 2016 Author: Cassie Rowley & Sarah Mitchell PIN The Royal Surrey County Hospital NHS Foundation Trust 2013