Effect of Thoracolumbosacral Orthoses on Reachable Workspace Volumes in Children With Spinal Cord Injury

Abstract Background/Objective: Wheelchair users often use trunk motion to facilitate or augment their upper extremity reach. Children with spinal cord injury (SCI) are often prescribed thoracic lumbar sacral orthoses (TLSO) to delay or prevent spinal curve progression. The impact of wearing a TLSO while reaching has not been studied. Therefore, the purpose of this study was to see the quantitative effect of the TLSO on reachable workspace volumes and reach of children with SCI. Methods: Twenty children with SCI aged 5 to 18 years participated in the present study. Three-dimensional upper extremity motion analysis was used to assess the reachable workspace patterns of children reaching for targets at varying heights. Volumes in and out of TLSO and kinematic ranges of reach were statistically analyzed using paired Student’s t tests with a P value set at 0.05. Results: Reachable workspace volumes were significantly greater for the non-TLSO condition compared with the TLSO condition (112,836 vs 80,711 cm3; P = 0.0002; a decrement of 28%). Anterior posterior and medial lateral ranges of reach were statistically greater in the non-TLSO condition (P = 0.002, P = 0.01 ). Nondominant hand medial lateral reaches were statistically greater in the non-TLSO condition (P = 0.003). Dominant hand anterior posterior reaches were greater in the non-TLSO condition (P = 0.009). Conclusions: Results suggest the reachable workspace of children with SCI is lessened with the use of a TLSO. This may be an important negative factor for brace compliance in children with SCI. The TLSO interferes with their ability to reach; therefore, children may prefer not to wear the orthosis.