Hagen Orthotics and Prosthetics, Inc

Hagen Orthotics and Prosthetics, Inc

Solutions for your orthotics and prosthetics needs

Upper Body

(Thoracolumbar Spinal Orthosis) Body Jacket

Your Physician has recommended that you wear a custom-fabricated TLSO to immobilize your thoracolumbar spine. The length of time you will need to wear the TLSO will depend upon your condition and is determined by your physician. DO NOT get out of bed without your TLSO unless you have permission from your physician.

Hagen Orthotics and Prosthetics, Inc

Design and Fabrication

The TLSO is customized to fit your dimensions. The lightweight and hygienic materials are the highest quality available. The soft liner is closed-cell polyethylene foam. The outer shell may be either rigid foam or rigid thermoplastic and will be customized to your needs. The liner and hard outer shell are heated in a large oven to 390°. They are draped and vacuum formed over your model, cooled, trimmed, and cut. The edges are finished and polished.

Application (Putting it on)

The TLSO has two pieces, a back, and a front. The front overlaps the back along the sides. Lying on your back, log roll and slide the back section under your side. Roll back and adjust for comfort. Your back should lie comfortably and feel the support of the TLSO. If you have had surgery, your incision may be tender but will improve with time.

Place on the front section, overlapping the back, so the inside seam along each side is smooth. Gently fasten the Velcro to a firm but comfortable tightness.


Clean your brace with mild soap and water and towel dry. If your physician allows, you may shower wearing the brace. The Velcro straps will be the only parts that absorb water.

Wearing a cotton t-shirt under the TLSO reduces irritation. Clean your TLSO to prevent bacteria build-up and reduce skin irritation.

SOMI Brace

Your Physician has recommended that you wear a SOMI brace to provide support, correct deformities, and prevent specific joint and body movement. The SOMI brace holds your neck in a straight line with your spine, providing rigid support to the unstable and weakened muscles and bones of your neck. The brace prevents movements and protects your neck injury as it heals. Your Orthotist will provide proper instructions during the fitting of your brace. The SOMI brace should be worn and adjusted only as your physician instructs.

Parts of the Brace

Chin Piece

The chin piece supports your lower jaw by forming a cup for your chin to rest. It is attached to the headpiece by straps and a front metal extension to the chest piece. It must be worn when walking and whenever active movement of the head and neck would occur. The chin piece may be removed only when instructed by your physician.


The headband straps across the forehead and is fitted to a plastic device at the back of your head. You must wear the headband whenever you have removed the chin piece. Activities may include eating, bathing, and shaving.

Occipital piece

The occipital piece supports the base of your head and helps hold your head in an upright position.

Chest piece

The chest piece rests upon your chest and connects to the chin and occipital pieces. The chest piece and occipital piece should be removed only when instructed by your physician.

Switching the Headband and Chin Piece:

  • 1 Attach Velcro band across the forehead
  • 2 Unsnap chin piece from occipital piece
  • 3 Re-snap headband to occipital piece
  • 4 Remove chin piece only when the headband is attached
  • 5 To reattach chin piece, replace chin piece to occipital piece
  • 6 Remove headband
  • Always return the piece to the indicated mark on the front extension
  • Use a mirror to check the position of your head when changing pieces
  • Check your chin and lower jaw for redness and skin problems each time you switch pieces
  • Chin piece should be worn during periods of walking, riding in a car, and activities which place any stress on the neck muscles.


A daily routine of skin care is important, to prevent skin problems.

For most people, a sponge bath is the best method of daily cleansing. Areas in direct contact with the brace, such as your chin and lower jaw, may need more frequent cleaning.

Inspecting your skin is important, especially those areas that receive pressure, rubbing, or friction from the brace. Irritations may develop over bony areas such as the chin and jawline, shoulder bones, and back of the head. Reddened or bruised areas are the first clues to developing skin irritations.

Signs of skin irritation:

  • Indentation or marks on your skin
  • Bruises
  • Blisters
  • Swollen or puffy areas
  • Abrasions
  • Scrapes or Cuts
  • Reddened areas
  • Rashes

Check your chin and jawline closely for signs of irritation. This area receives constant pressure and is most likely to develop skin problems. Alternating the chin piece and headband will help prevent skin irritations in this area.

Wearing a light cotton T-shirt under the SOMI brace serves as a cushion and absorbs perspiration. You may prefer to wear T-shirts that are slightly larger than your usual size. Changing T-shirts daily is best accomplished with the assistance of another person and always while lying on your back.

To put on a T-shirt, place the T-shirt over your head and pull it down to your neck. Remove the chin piece and pull the T-shirt down enough to allow the placement of one arm into a sleeve and then the other. Pull the T-shirt under the brace, making sure to pull out all wrinkles. Reverse this process to remove the T-shirt, and always do this while lying on your back.

General Information

  • Your brace should not be altered or removed without your physician's consent.
  • The headband or chin piece must be in place at all times. The chin piece should be worn most because it best supports your neck and head.
  • Follow daily skin care and hygiene routine.
  • Those areas likely to develop irritation may be padded to minimize pressure and friction. A T-shirt, soft clothes, adhesive Band-Aids, or thin foam may be used to act as a cushion between the brace and your skin.
  • A front button shirt is recommended for over the brace allowing for easier removal and application of the chin piece.
  • If possible, have another person become familiar with the process of changing the chin piece and headband.

Call the hospital and ask for the orthopedic resident on call if any of the following symptoms develop:

  • Increasing discomfort caused by the brace
  • A sore caused by pressure over an area
  • Numbness or tingling in extremities
  • Increased pain
  • Inability to move arm or hand
  • Extremity weakness


Orthotic therapy for moderate to severe wrist, hand, finger joint stiffness or contractures, wrist contractures (flexion or hyperextension), radial or ulnar deviation of the hand, flexion/hyperextension contractures of the MP/IP joints of the fingers and adduction of the thumb.

Hagen Orthotics and Prosthetics, Inc

Treatment rationale

The orthotic device can be used to restore lost range of motion or to maintain range while providing support and protection and corrected positioning of the affected joints. The SHFO is hand bendable to provide the desired therapy and positioning of the wrist, hand, and fingers. Two incrementally larger MP/IP extension rolls are used to gradually extend the MCP and PIP joints of the fingers. Ulnar or radial drifts of the hand can be treated by device modification. Thumb abduction is increased as incrementally larger MP/IP extension rolls are added. By increasing wear time to three to six hours of use, the total end range time or device wear provides long effects stretch and permanent increases in joint range of motion of time. Orthotic treatment should be continued until function is restored.


Increase wrist, hand, and finger (including thumb) range of motion improve the hygiene of the hand, and where possible, improve functional ability of the fingers/hand to assist with activities of daily living.


  • 1 Use Prom or Neurostretch sub-maximal passive stretching to the point of noticeable resistance only (no discomfort) to passively stretch the affected joint capsule(s) connective tissue, tendons, and muscles. Concentrate on the wrist and thumb locations prior to placing any extension force on the fingers or thumb.
  • 2 To treat ulnar or radial deviation of the hand bend the palmar bar level providing 5° to 10° of progressive extension stretch towards neutral from the point of resistance to passive stretch. This will provide the optimal gentle stretch of the affected joint.
  • 3 Select appropriate size MP/IP extension roll (when appropriate) and place over the palmar bar, guiding the palmar bar strap through the roll.
  • 4 The orthotic wrist base may be hand molded as needed. Provide approximately 5° to 10 ° of additional wrist stretch to maximize patient outcomes in treating wrist flexion or hyperextension.
  • 5 Gently roll the palmar bar of the device under the fingers into the palm of the hand with the strap end approximately one inch from the thumb web space. The SOFTPRO TM grip WHFO long opponens frame should be centered along the medial side of the forearm. Attach the three SHFO straps (forearm, wrist, fingers) to secure the device in place without creating unwanted pressure on the skin.
  • 6 After initial device application, the affected tendon(s) should fee stretched with no pain or discomfort. After 15 minutes of wear, softening or relaxation of the tendon(s) indicated that the joint is predisposed to long effects of therapeutic stretch.
  • 7 Gradually increase wearing time to three hours or more to achieve the total end range time that will provide long effects stretch.
  • 8 Determine wearing schedule based on patient tolerance, therapy evaluation, and physician orders.

Check for skin redness, pressure, and potential discomfort every two to three hours. Evaluate red areas using the Blanch Test. Remove the orthotic device immediately if significant redness, pressure, or pain and discomfort are evident. Discontinue use until skin integrity or comfort issues are resolved. Device or wearing schedule modifications may be made to eliminate skin integrity and comfort problems.

A significant wearing schedule disruption often requires a re-adaption period. A gradual re-introduction and increased wearing endurance may be necessary. Note wearing schedule changes in the patient’s care plan.


  • 1 Remove the soft cover from the frame, remove the soft cover from Palmar rolls
  • 2 Close all hook and loop attachments on soft cover and place in a laundry bag
  • 3 Hand or machine wash on gentle cycle with mild detergent. Do NOT use commercial washers or hot water, bleach or fabric softener
  • 4 Air dry

Follow manufacturer’s instructions for care of the orthotic device. Always inspect the device between applications to ensure the soft goods are properly in place, the device settings have not been altered, and the device has not been soiled or would provide any other risk to the patient prior to application.