PATIENT CARE GUIDELINES FOR SCOLIOSIS ORTHOSIS
A goal is to wear the brace 23 hours a day by 2-3 weeks. This requires:
- Your brace be put on properly.
- Your skin be looked after.
- Your brace be cleaned daily.
- You to start your brace wearing gradually.
PUTTING THE ORTHOSIS ON
Proper brace application initially TAKES TWO PEOPLE – the wearer and a helper. This keeps the brace from being twisted when it is put on. The brace is worn over a cotton undershirt. For girls the brace is worn over the bra, but underpants should be worn over the brace.
- The wearer stands up and the helper stands behind holding the brace in the left hand.
- The helper puts the brace in front of the patient with the opening at the back.
- The helper reaches around the patient with an arm on each side of the patient and spreads the brace wide enough so the patient can step into the brace.
- Make sure all the straps are outside the plastic girdle. Make sure the brace is not twisted and is facing straight ahead. The opening of the brace should be in the middle of the back, so that the bumps on the spine and the crease between the buttocks are halfway between each edge.
- BEND YOUR HIPS AND KNEES about 45 degrees. The brace will only fit properly if this is done. The wearer holds his/her hands on the hips.
- With hands on the “hips” of the brace push the brace toward the feet so that the sausage shaped pads on the inside of the brace fit above the hip bones.
- Pull the extra cloth of the undershirt out at the brace opening. Make sure there are no wrinkles in the undershirt.
- The helper threads the straps through the buckles and fastens the buckles loosely.
- Tighten the brace by applying pressure to the side of the brace opposite to the buckle opening. If unable to secure the brace this way, the wearer may lie on a firm surface.
- If using the “side lying method” secure brace loosely, lie on the floor, bend knees and the helper leans on the side of the brace, squeezing the brace to the lines, while pulling the straps.
- When the brace is on as tightly as possible, fasten the buckles. At first the brace will only be buckled up to the line on the strap put there by the doctor or orthotist. Later, when the patient is used to the brace it will be buckled as tightly as the helper can do it.
It is very important to PREVENT SKIN BREAKDOWN (that is sore, red, raw skin). The skin under the brace needs to be toughened up, especially where the brace presses the hardest TO PROTECT THE SKIN.
- Bathe daily (bath or shower).
- Apply rubbing alcohol with your hands to all parts of the skin that the brace covers especially the areas where the skin is pink and the areas where the brace presses. Simply rub the alcohol into the skin. The alcohol plus the friction between your hand and body toughens the skin.
- Always wear a cotton undershirt, tubular knit without side seams.
- The skin will need frequent observing when the brace is first used (look for red areas).
- DO NOT USE CREAMS or LOTIONS under the brace. When dry skin occurs, call your pediatrician or NP.
- Always wear a soft undershirt or T-shirt under the brace. The sleeveless men’s tank top is usually preferred by girls.
- If you wear the brace loosely, it will move around and cause more skin problems by rubbing. WEAR YOUR BRACE AS TIGHTLY AS POSSIBLE. If there is skin breakdown (sore, red, raw skin) the brace must not be reapplied until the skin heals – usually in a few days. If this happens, call your Orthotist. The problem may be solved over the phone.
Sometimes the skin over the waist and hips gets darker. That is common and is not a problem. When the brace treatment is over, this color will go away. GOOD SKIN CARE REQUIRES BRACE WASHING EACH DAY.
CLEANING THE BRACE
The hard plastic outer shell and the inner soft foam plastic SHOULD BE CLEANED EVERY DAY. A cloth with soap and water can be used to clean the lining followed by rinsing with a damp cloth. A terry towel can help dry the foam plastic. The brace will dry by itself in 20-30 minutes. If the brace is needed soon, a very cool hair blower can be used to dry it in 5-10 minutes. The outer plastic can tolerate rough cleaning. The plastic brace should not be left in very hot sun or by a warm radiator as the plastic may soften and lose its shape.Alcohol may also be used to clean the brace. Simply wipe out the inside of the brace with alcohol. This nwill prevent a soap build-up.
STARTING THE BRACE WEARING
Getting used to your brace is like getting used to some new tight shoes. The following program is designed to help your skin and muscles adjust to having the brace on. It is a gradual build-up of time that usually takes 2 to 3 weeks.
GOAL: TO WEAR THE BRACE FOR 4 HOURS
- Apply the brace properly and wear it for one hour. Take the brace off and check your skin and give skin care by putting the alcohol onto your hand and rubbing it into your skin.
- If the skin is PINK, put the brace back on for two or more hours then check the skin again. Do this again for a 3-hour period.
- If the skin is RED or sore, the brace must be left off for a half hour then put on again.
- It is important that you can tell the difference between PINK and RED skin. The Orthotist will help you with this when you first get your brace.
- During the school year this stage is easily done after school.
- This stage usually lasts 5-7 days.
GOAL: TO WEAR THE BRACE FOR 10 HOURS
- If the brace is well tolerated for Stage I, the next stage is wearing the brace for 10 hours. It is difficult to accomplish this stage during a school day, so this stage is best done during a weekend.
- Start by putting the brace on for 4 hours. Then check the skin and give skin care. Put the brace back on and in 2 hours check the skin. Give skin care and put the brace back on. Repeat this every two hours until you have worn the brace 10 hours.
- At any time, if the skin is RED and SORE, wait a half hour before putting the brace back on.
- This stage usually lasts one weekend.
GOAL: TO WEAR THE BRACE FOR 18 HOURS
- Once the brace is tolerated for 10 hours you can proceed to wearing the brace for 18 hours a day. This can be done by putting the brace on in the morning before going to school.
- Four hours later, at lunchtime, take the brace off and check your skin and rub with alcohol. Put the brace on again. You’ll need the help of a school nurse or friend for this and she’ll need to learn how to apply your brace. After school take the brace off, check the skin and give skin care.
- Leave the brace off for 4-5 hours and reapply at bedtime.
- Leave the brace on all night. It should be worn all night without checking unless you complain of excessive discomfort. If this happens, leave the brace off and start again tomorrow with Stage III, step 1.
- This stage is harder because most people are very nervous about wearing the brace to school at first.
- This stage will usually last 2-3 days.
GOAL: TO WEAR THE BRACE 23 HOURS A DAY
- Once you can sleep in the brace overnight, you move on to wearing the brace all day and night except for one hour. The hour out of the brace is used for skin care, brace washing and the out-of brace exercise (remember you have exercises to do in the brace as well).
A HELPFUL SCHEDULE IS:
Before bed wash the brace. While it is drying, do your exercises, take a bath or shower and give skin care. Put on a clean undershirt, then put the brace on for the night. In the morning take the brace off for skin care and put on a clean undershirt. Put the brace back on. After school take the brace off for skin care. Put on a clean undershirt and put the brace back on.
SOME NOTES ON SKIN CARE
- Do not move on from one stage to the next until the first is completed.
- Continue the Stage IV skin care regimen after you are comfortable in the brace.
- Report skin problems to your doctor or nurse, who may suggest an alternate skin care technique.
- Make an earlier clinic appointment if your brace or skin problems continue.
- Initially the brace may be loosened slightly during meals if needed. Eating smaller portions more frequently may help.
As a rule loose fitting clothes will not reveal the outline of your brace. Pants usually will be at least one size larger. Pants with elastic waistbands or drawstrings may fit more easily.
WHAT CAN YOU DO IN THE BRACE?
Almost anything you want to try in your brace is all right- basketball, baseball, horseback riding, gym, tennis. You can swim in your brace if need be, so be sure to try it first so you won’t be afraid of falling when sailing. If you swim in salt water, wash the brace well with fresh water, then towel dry it. Generally you may swim without your brace since the water will support your back. Check with your doctor for specific instructions about swimming and other activities. Your bicycle seat may also need adjustment. The seat may need to be raised since the brace may interfere with pedaling!
It is VERY important to keep any follow-up appointments made by your orthotist. We are here to help you and make your experience with Synergy as pleasant as possible.
For questions or to schedule an appointment, call Synergy at 510-770-9010. We look forward to working with you!