1. Abstract Thoraco Lumbar Sacral Orthotic (TLSO) braces are used to immobilize the spine following injuries or surgical procedures. Current bi-valve brace designs are difficult to put on, which often leads to improper placement procedures and ill fit. A Three-Segment TLSO brace was designed to counter these problems while providing the same level of support. A prototype was constructed, and verified with orthotics specialist and self- placement tests. The results indicate that the Three-Segment brace was faster to place, with less required movement than the bi-valve design. The design was further validated by approval from orthotics and rehabilitation specialists. In conclusion, the Three-Segment brace offers a viable alternative to current bi-valve designs. Three-Segment Thoraco Lumbar Sacral Orthotic Brace D. Hower, A. Ravindra, J. Schaberl, K. Zawrotny Introduction Many people require the use of a thoraco lumbar sacral orthotic (TLSO) brace to fully recover from either a spinal injury such as a compression or burst fracture, or a surgical procedures such as spinal fusion, decompression, or treatment for ankylosing spondylitis. Proper use of the TLSO brace will inhibit bending and twisting of the upper body, which allows the spinal cord to heal in an acceptable amount of time. Currently, the bi- valve TLSO brace (Figure 1) is the most commonly used design. Since it is difficult to put on correctly, improper placement procedures are often followed, leading to ill-fit of the brace. The difficulty with bi-valve brace placement is largely the result of the single, rigid back segment. This piece must be slid underneath the patient while they lie on their side; an often painful and extremely difficult process for patients lacking assistance. In order to avoid this discomfort, patients often sit or stand to put on the TLSO brace, which adds load to the spine. This can cause more pain to the patient, and prevent the brace from fitting correctly. The project objective was to redesign the TLSO brace to improve ease and speed of correct placement. The new brace should provide the same level of support afforded by a bi-valve brace, and should not introduce significantly higher costs to the customer. Materials and Methods Design Development: Consultation with Orthotics and Rehabilitation Specialists were used to guide the design of the Three-Segment TLSO brace (Figure 2). This design features split back segments, which do not require any portion of the brace to be slid under the patient. The back segments are connected to the front piece by hinges, allowing for easier manipulation of the brace. The brace is fastened by three non-Velcro straps, which allow for a faster connection process. Prototype Fabrication: A mold of a test subject was fabricated by applying several layers of wet plaster bandages around the torso, and allowing them to dry. This plaster cast was then removed and filled with molding plaster to obtain a positive mold. Plastic was vacuum-folded around the mold. Finally, AliPlast was applied to the inside of the brace. Additional steps were taken to add hinges and straps to complete the brace. Testing Procedures: The first test conducted with the Three-Segment TLSO brace was a timed trial of brace placement performed by an orthotics specialist. A Hanger Orthopedic Group staff member with experience in putting on TLSO braces was timed while placing the original bi-valve brace and the Three-Segment brace on the test subject three times. The second test compared the ability of the test subject to place the bi-valve brace versus the Three-Segment brace without assistance. Both time and rolling requirements were quantified in this test. Results Results of the orthotics specialist test can be found in Table 1. The average time required for the orthotics specialist to place the bi-valve brace was 89.3s. The average time required for the orthotics specialist to place the Three-Segment brace was 45s. Results of the self-placement test can be found in Table 2. The average time for placement of the bi-valve brace was 117s, with 2.8 log rolls required. The average time for placement of the Three-Segment brace was 99s, with 1.5 log rolls required. Discussion The results indicate that the Three-Segment TLSO brace can be placed faster than the bi-valve brace. This was true in the orthotics specialist test as well as the self-placement test. It is especially significant that the Orthotics Specialist, with 25 years of experience placing bi-valve braces, was able to place the Three-Segment brace in half the time. The faster times indicate that the Three-Segment TLSO brace is more easily placed than a bi-valve brace, for both healthcare professionals and patients. Further, the self-placement test demonstrates that less rolling is required to place the Three-Segment TLSO brace. Less movement is desirable as it reduces pain caused to the patient during placement. Therefore, improper placement procedures are less likely to be followed. The design of the Three-Segment TLSO brace was validated through consultation with Rehabilitation and Orthotics Specialists. Both professionals claimed to feel comfortable in prescribing the new design to patients with back injuries. Acknowledgments Thanks to the generous gift of Drs. Hal Wrigley and Linda Baker, the BioEngineering Department, Bob Mawhinney and the Hanger Orthopedic Group Staff, Dr. Boninger, Dr. Fulay, and Andy Holmes Brace TypeTrialTime (sec) Bi-Valve 1 83 2105 380 Three- Segment 140 245 350 Brace TypeTrialTime (sec)Number Rolls Bi-Valve 11303.5 21112.5 31092.5 Three- Segment 11031.5 2991.5 3951.5 Table 2: Results of Self-Placement Tests Table 1: Results of Orthotics Specialist Test Figure 1: The bi-valve TLSO braceFigure 2: The three-segment TLSO brace Caption 1: A picture of the bi-valve TLSO braceCaption 2: A picture of the three-segment TLSO brace