The Effect of Alignment Changes on Unilateral Transtibial Amputee’s Gait: A Systematic Review

IntroductionProsthetic alignment, positioning of a prosthetic foot relative to a socket, is an iterative process in which an amputee’s gait is optimized through repetitive optical gait observation and induction of alignment adjustments when deviations are detected in spatiotemporal and kinematic gait parameters. An important limitation of the current prosthetic alignment approach is the subjectivity and the lack of standardized quantifiable baseline values. The purpose of this systematic review is to investigate if an optimal alignment criterion can be derived from published articles. Moreover, we investigated the effect of alignment changes on spatiotemporal, kinematic and kinetic gait parameters.ResultsA total of 11 studies were included, two controlled before-and-after studies and nine-interrupted time series studies.DiscussionThe results demonstrate that alignment changes have a predictable influence on the included kinetic parameters. However, the effect of alignment changes on spatio-temporal and kinematic gait parameters are generally unpredictable. These findings suggest that it is imperative to include kinetics in the process of dynamic prosthetic alignment. Partially this can be established by communication with the prosthetic user in terms of perceived socket comfort, but the use of measurement tools should also be considered. While current literature is not conclusive about an optimal alignment, future alignment research should focus on alignment optimisation based on kinetic outcomes.引言：假肢对线（prosthetic alignment），即假肢脚板相对于假肢接受腔（socket）的位置调整，是一项反复迭代的流程。截肢者需通过反复开展光学步态观测，并在时空步态参数（spatiotemporal gait parameters）与运动学步态参数（kinematic gait parameters）出现偏差时调整对线参数，以此优化自身步态。当前假肢对线方法的重要局限在于其主观性，且缺乏标准化的可量化基准值。本系统综述旨在探究能否从已发表的文献中推导得到最优对线标准；此外，本研究还分析了对线调整对时空、运动学及动力学步态参数（kinetic gait parameters）的影响。 结果：本研究共纳入11项相关研究，其中2项为对照前后研究，9项为间断时间序列研究。 讨论：研究结果表明，对线调整对纳入分析的动力学参数具有可预测的影响。然而，对线调整对时空及运动学步态参数的影响通常难以预测。上述发现提示，在动态假肢对线流程中纳入动力学参数评估至关重要。该目标可部分通过与假肢使用者沟通其对接受腔舒适度的主观感知实现，但同时也应考虑引入量化测量工具。尽管目前的文献尚未就最优对线方案达成共识，未来的假肢对线研究应聚焦于基于动力学结果的对线优化工作。