Correction: The Effect of Alignment Changes on Unilateral Transtibial Amputee's Gait: A Systematic Review.

[This corrects the article DOI: 10.1371/journal.pone.0167466.].

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

INTRODUCTION: 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. RESULTS: A total of 11 studies were included, two controlled before-and-after studies and nine-interrupted time series studies. DISCUSSION: 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.

Cadence, energy expenditure, and gait symmetry during music-prompted and self-regulated walking in adults with unilateral transtibial amputation.

BACKGROUND: Walking cadence has shown promise for estimating walking intensity in healthy adults. Auditory cues have been shown to improve gait symmetry in populations with movement disorders. We investigated the walking cadence-energy expenditure relationship in unilateral transtibial amputees (TTAs), and the potential of music cues for regulating walking cadence and improving gait symmetry. METHODS: Seventeen unilateral TTAs performed 2 5-min treadmill walking trials, followed by 2 5-min overground walking trials (self-regulated "brisk" intensity, and while attempting to match a moderate-tempo digital music cue). RESULTS: Walking cadence significantly (P < .001) and accurately (R(2) = .55, SEE = 0.50 METs) predicted energy expenditure, and a cadence of 86 steps·min(-1) was equivalent to a 3-MET intensity. Although most participants were able to match cadence to prescribed music tempo, gait symmetry was not improved during the music-guided condition, compared with the self-regulated condition. CONCLUSIONS: This is the first study to investigate the utility of walking cadence for monitoring and regulating walking intensity in adults with lower limb prosthesis. Cadence has similar or superior accuracy as an indicator of walking intensity in this population, compared with the general population, and adults with a unilateral TTA are capable of walking at moderate intensity and above for meaningful bouts of time.

Design of manikin for testing of residual-limb shape-capture method: technical note.

Consensus is still lacking on how best to capture the shape of a residual limb. Computer-aided design systems have not proven more accurate, repeatable, or reliable than traditional plaster of paris methods. Research is limited in design, relates to clinical trials, and is based on opinions and clinical experience. Many outcome measurements are based on qualitative estimations of prosthetic fit or patient feedback rather than quantitative measurements. Research must identify the most accurate, repeatable, and reliable methods for residual-limb shape capture under conditions most likely to enhance socket fit. Measurement is difficult because a reference grid is required for identifying the residual limb's axis for ensuring direct comparison. This article describes a manikin production method for testing the shape capture of the residual limb. Diameters and volume were measured at specific levels with a programmable computer numerical control milling machine and a displacement tool, with a combined accuracy of 5 micrometers.

Dynamic interface pressure distributions of two transtibial prosthetic socket concepts.

In this study, we investigated and compared the dynamic interface pressure distribution of hands-off and hands-on transtibial prosthetic systems by means of pressure mapping. Of the 48 established unilateral amputees recruited, half (n = 24) had been wearing pressure-cast prostheses (IceCast Compact) and the other half (n = 24) had been wearing hand-cast sockets of the patellar tendon bearing design. We measured the dynamic pressure profile of more than 90% of the area within each prosthetic socket by means of four Tekscan F-Scan socket transducer arrays. We compared the interface pressure between socket concepts. We found that the distribution of dynamic pressure at the limb-socket interface was similar for the two intervention (socket prescription) groups. However, a significant difference was found in the magnitude of the interface pressure between the two socket concepts; the interface pressures recorded in the hands-off sockets were higher than those seen in the hands-on concept. Despite the differences in interface pressure, the level of satisfaction with the sockets was similar between subject groups. The sockets instrumented for this study had been in daily use for at least 6 months, with no residual-limb health problems.

Magnetic resonance imaging technology in transtibial socket research: a pilot study.

Investigations into the shape and volume of transtibial prosthetic sockets are complicated because of the difficulty in establishing an accurate reference grid. Magnetic resonance imaging (MRI) presents a possible solution to this problem. However, the reliability of MRI in defining the residual-limb/cast interface depends on the scanned image not being distorted by the materials present. We investigated the potential of MRI technology to establish the desired reference grid. Distortion from the so-called "chemical shift" may influence the MRI when certain materials are used during the casting process. These materials include plaster of paris (POP) and silicone (in the form of an interface liner). POP is commonly used to capture the shape of the residual limb. However, if the casting technique requires the use of a silicone liner, the liner is placed over the residual limb first and then the POP is applied over the liner. Experimental results indicate that the materials used do not distort or interfere with the scanned image. The object segmentation process that extracts the bone and skin from an MRI scan and enables the establishment of the required reference grid was explored. Results show that extracting the bone structure and using it as the reference grid to quantify the differences in volume and shape of the soft tissues of the residual limb is feasible.