title: The Effect of Alignment Changes on Unilateral Transtibial Amputee's Gait: A Systematic Review.
abstract: Prosthetic 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.
  
  
  
  A total of 11 studies were included, two controlled before-and-after studies and nine-interrupted time series studies.
  
  
  
  The 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.
authors.affiliation: Department of Orthopaedic Technology, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands.|Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom.|Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: Jonkergouw
authors.affiliation: Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands.|Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands.|Department of Physical Therapy, HU University of Applied Sciences Utrecht, the Netherlands.
authors.forename: Maarten R
authors.initials: MR
authors.lastname: Prins
authors.affiliation: Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom.
authors.forename: Arjan W P
authors.initials: AW
authors.lastname: Buis
authors.affiliation: Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands.|Department of Physical Therapy, HU University of Applied Sciences Utrecht, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Wurff
mesh_terms: D000674:Amputees; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D005684:Gait / Q000502:physiology*; D006801:Humans; D065186:Interrupted Time Series Analysis; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods* / Q000592:standards; D016059:Range of Motion, Articular; D013977:Tibia