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Category: Neurology, phantom sensations

User perspective on the rubber hand illusion in a wider sense – prosthetic arm and ownership for real use [reflection and consideration]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - User perspective on the rubber hand illusion in a wider sense – prosthetic arm and ownership for real use [reflection and consideration]; published January 2, 2019, 22:16; URL: https://www.swisswuff.ch/tech/?p=8882.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - User perspective on the rubber hand illusion in a wider sense – prosthetic arm and ownership for real use [reflection and consideration]}}, month = {January},year = {2019}, url = {https://www.swisswuff.ch/tech/?p=8882}}


The year 2018 was interesting in relation to the rubber hand illusion subject.

I had participated in an extensive interview study regarding embodiment just a year before [link]. Then, I had been identified as a prosthesis "super user" [link] - these people wanted to investigate my type of "embodiment" through fMRI, but we quickly identified my prosthetic arm design (not my brain) as the key aspect regarding the question of why I have a prosthesis that I can actually use rather than just pose with as so many others. My own view here clearly is that if you are after embodiment, you have to go all Sherlock Holmes, you have to go all forensic, all CSI and all crime mystery: and as in "cherchez la femme" when looking for a motive in a crime, it is "cherchez le bras" when studying embodiment: for all issues that center around prosthetic use, go for the core physical aspects first. There are extremely bad things that may, can, and will happen if you do not make that your real first priority. The "rubber hand illusion" is an extreme variation of body ownership of a rubber hand that does not even touch a person and still that person thinks they are being touched if that rubber hand is touched. The illusion to make an amputee believe they embody or bodily own a prosthetic hand is quite different. But both pose risks, whereas the risk that an amputee faces when getting a prosthetic arm that is integrated into his body image has not been considered yet. My slightly experience based consideration proposes that the body image is tyrannically governed, for good and for bad, and if the prosthetic body part - already starting with bad cards, body image wise - craps out, and it always does so far too often, then it draws the hot red angry ire, the depressed disappointment, the falling apart of the cyborg body, of the amputee - and definitely not the cool "oh a neutral object just disintegrated" that one will wish for from a societal, insurance or repair view. The integration into a body image brings with it that the device becomes subject to totally tyranically governed bodies. When it is difficult enough to make any device ready for real world usage, making it ready to survive tyrannies of that nature will be even harder. I proposed an unforgiving approach to failure testing in a recent paper (link) but I cannot say that paper has been greeted with any enthusiasm by the industry that actually builds prosthetic arm components. Because they get to directly face the anger, hate, and rejection of all the users that they had not informed well of just how fragile their prosthetic arm parts really are (link), and they are in absolutely no position to technically improve these parts. So, manufacturers go into hiding. They do not want many users - they want users that buy and do not complain. The last thing they need is a hard bright unforgiving look into just how bad their engineering is. Every non-user, every rejector, should be cautiously left alone, not recruited to wear a prosthesis - because the risk is considerable (link). Researchers currently have the problem that amputees run away, everywhere (link), also because we are continously treated as mentally incompetent. So in essence, we are a group of people that increasingly realizes the extent to which we are being fooled, being had, told stories, and increasingly, we are getting critical. Potential rubber hand illusion switches, dragged to market to be soldered into prosthetic arms, if ever they are a medical treatment or a part thereof, will have negative effects as well: what are these? What do we know about deeply problematic aspects of bodily ownership? I had been invited to talk about that aspect for a group of people interested in robotic control and user interfaces, on December 7th 2018, in Mannheim (Germany). The presentation that I gave now is typed out here in more detail for further reference.

Rubber hand illusion is an idea that, by and large, was somehow transformed into multi-sensory rubber hand illusion, and they now want to put it into prosthetic arms to make users believe the prosthesis belongs to their bodies.

With that, rubber hand illusion goes to market1)As in: piggy goes to market..

This is not really that fascinating. While I am not interested in prosthetic arms because I find the field fascinating, I have been drawn into the field due to circumstances. And as much as you feel that I am locked into this constraint space of shared idiocies, dreams, hopes and failing hardware together with you, in some type of brotherhood by bad fate, you may also realize you are locked into this with me, as consequence of bad fate. Those then are also circumstances. As I deal with it, you may also have to find a way. If you think that is uncomfortable, send me a mail, so we may talk about uncomfortable a bit.

The ultimate consquence of this piece of reflection is not at all bad, however. We will see just how too much "ownership" has bad aspects as well. It risks to slip prosthetic hands into a domain where it is subject to the most vicious decision making that there is: tyrannic and wilful, impulsive and emotional decision making within one's own very personal domain of body or body image with owned body part dependent urgencies and requirements. To withstand these storms, a  prosthetic arm has to withstand not only the physical requirements of real life use (which it normally does not to a degree that will make your jaw drop), it also has to be acknowledged in that capacity by manufacturers and care-givers, emergency teams or repair units, where none of similarly urgencies are currently provided.

To even reach a level of "tool", to be useful enough to be accepted as technical solution (not as embodied "owned" limb), a typical prosthetic arm may have to undergo a most serious metamorphosis, from commercial parts (link)(link) to tuned and optimized parts (link). If you are in R&D and want to do something good in support of arm amputees, it may be relevant to address actual issues such as failing devices or phantom pain (link), before going all out on a limb and drag ill-defined concepts to a domain where they may wreck more than they really help.

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Footnotes   [ + ]

1. As in: piggy goes to market.

Coping with my own phantom pain {update: vascular congestion and cold skin: compression really helps}

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Coping with my own phantom pain {update: vascular congestion and cold skin: compression really helps}; published December 17, 2018, 22:07; URL: https://www.swisswuff.ch/tech/?p=9034.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Coping with my own phantom pain {update: vascular congestion and cold skin: compression really helps}}}, month = {December},year = {2018}, url = {https://www.swisswuff.ch/tech/?p=9034}}


I have gone after possible sources of my phantom pain, over the past years, to better cope with it.

There are aspects that I can influence directly, and others that I seem to be able to direct only indirectly.

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Electromagnetic shielding and phantom pain [tech corner]

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Wolf Schweitzer: Technical Below Elbow Amputee Issues - Electromagnetic shielding and phantom pain [tech corner]; published May 23, 2016, 19:57; URL: https://www.swisswuff.ch/tech/?p=5981.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Electromagnetic shielding and phantom pain [tech corner]}}, month = {May},year = {2016}, url = {https://www.swisswuff.ch/tech/?p=5981}}


Electromagnetic interference or EMI is supposed to contribute to phantom pain. We do not know why that is. Other theories attribute phantom pains to an efference/afference dysbalance. Apparently, mirror therapy works but not in all cases.

But, what do we know.

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Phantom pain and phantom sensations

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Wolf Schweitzer: Technical Below Elbow Amputee Issues - Phantom pain and phantom sensations; published March 8, 2013, 00:11; URL: https://www.swisswuff.ch/tech/?p=1480.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Phantom pain and phantom sensations}}, month = {March},year = {2013}, url = {https://www.swisswuff.ch/tech/?p=1480}}


Phantom pain is for real, and as it is, I can describe what there is to say about it.

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Caffeine and Ibuprofen, Paracetamol and pain control [reference to two studies]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Caffeine and Ibuprofen, Paracetamol and pain control [reference to two studies]; published September 11, 2012, 06:14; URL: https://www.swisswuff.ch/tech/?p=875.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Caffeine and Ibuprofen, Paracetamol and pain control [reference to two studies]}}, month = {September},year = {2012}, url = {https://www.swisswuff.ch/tech/?p=875}}


Sometimes, the right combination is better than stuff with far more side effects. People never understand why I like coffee that much. But then, maybe some of you all also want to improve pain control at less side effects and less cost.

What really seems to matter here is the correct ratio more than dosing high to begin with. That means that for each cup of coffee (100-200 mg caffeine), about 4-5 times that amount of ibuprofen (that is, Ibuprofen 400 or 800) appears to work best according to that study.

Read this from http://www.ncbi.nlm.nih.gov/pubmed/16872598:

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Phantom pain visualization

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Phantom pain visualization; published September 10, 2012, 22:17; URL: https://www.swisswuff.ch/tech/?p=869.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Phantom pain visualization}}, month = {September},year = {2012}, url = {https://www.swisswuff.ch/tech/?p=869}}


Visualizing phantom pain is hard. I found this image rather illustrative though.

Pain Fest - exacerbation of postural muscle dysbalance, phantom pain and allodynia / tender skin [pain escalation]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Pain Fest - exacerbation of postural muscle dysbalance, phantom pain and allodynia / tender skin [pain escalation]; published October 2, 2011, 18:00; URL: https://www.swisswuff.ch/tech/?p=488.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Pain Fest - exacerbation of postural muscle dysbalance, phantom pain and allodynia / tender skin [pain escalation]}}, month = {October},year = {2011}, url = {https://www.swisswuff.ch/tech/?p=488}}


As I attended a conference last week, Monday through Saturday, most of the time was spent with static activities - standing, sitting, walking about slowly - while I was wearing my cosmetic arm. I managed to get relief from that type of activity by getting into a pool twice that week - but that didn't prevent this from happening. Twice a week just wasn't enough for that. Because in essence, I had an extreme escalation of pain. I never had that before, and can only speculate about the causes.

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Phantom limb, phantom world, phantom pain and Microsoft XBOX 360 with KINECT [hehe]

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Wolf Schweitzer: Technical Below Elbow Amputee Issues - Phantom limb, phantom world, phantom pain and Microsoft XBOX 360 with KINECT [hehe]; published June 26, 2011, 02:45; URL: https://www.swisswuff.ch/tech/?p=446.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Phantom limb, phantom world, phantom pain and Microsoft XBOX 360 with KINECT [hehe]}}, month = {June},year = {2011}, url = {https://www.swisswuff.ch/tech/?p=446}}


A while back I realized how the term prosthetic applies to so many of our add-on items. Since then we have also seen the rise to stardom of Amber Case. It now seems to be also terribly undefined and unclear exactly how an interface between stump and phantom replacement is supposed to look like.

One way to replace a phantom hand with a visual appearance is using a prosthetic arm. That has the disadvantage of being different and stiff, mostly unintuitive and clumsy, heavy, at times even smelly, some of the practical but most somewhat if not outright ugly - at least, comparing it with a more embedded experience.

Another way to replace a phantom hand is by using a mirror box. However, mirror therapy is a rather strenuous mental exercise. It also is not good for just anybody - my phantom pains, for example, got quite a bit worse with the mirror box.

And then, there is Microsoft XBOX 360 with KINECT.

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PHWWWWTTTTT!!!! Phantom pain visualization attempt [attempt!]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - PHWWWWTTTTT!!!! Phantom pain visualization attempt [attempt!]; published June 22, 2011, 00:51; URL: https://www.swisswuff.ch/tech/?p=445.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - PHWWWWTTTTT!!!! Phantom pain visualization attempt [attempt!]}}, month = {June},year = {2011}, url = {https://www.swisswuff.ch/tech/?p=445}}


This is by far the best visualization for my phantom pains that I have seen so far.

PHWWWWTTTTT!!!!

My phantoms are

  • burning, after being like fireworks for a while now they burn,
  • cold, and dripping wet, just like the phantom sensations that I have, but painfully so,
  • sudden or almost sudden,
  • aching, pulling and twisting,
  • second nature - strange, yes.

Hard to explain? Yes. There are a few triggers, as I get synaesthetic pains, something you surely do not want to even think about. Leave alone the consequences. But this visualizes it well.

Treatment? Forget treatment. My phantom hand is as rigid as they ever come - the pre-amputation hand was paralysed partly, seriously damaged, extremely painful and with that, mirror therapy is contra-indicated as some phantom hand flexibility is required. To no surprise, an attempt at mirror therapy significantly worsened the phantom pains for me. Drugs are not an option as I maintain my ability to drive and to compete in sports proudly. Pride and self determination go a very long way with me.

Is it bad? All things are relative. The phantom and stump pains now are a mere fraction of the pains I had beforehand (tumor getting "out of hand", untreated thrombosis of blood vessels inside the hand, massive inflammatory reaction to deep sutures). I then had to decide between two types of hell: hell "A" and hell "b" - with hell "A" being a remaining paralysed damaged thrombosed and inflamed, extremely painful hand with an unclear nodular tumorous process spreading and some people poking around in it that I would never even have wanted near me in a healthy state leave alone then, people that obviously then and even more now in hindsight did not know at all really what they were doing inside my hand as such and, also, with me as person and as individual patient, as suffering biography with a clear interest to free himself of such issues - and hell "b" with an amputation that would entail probable cure of whatever was spreading there, definite pain reduction (as discussed here) and plannable rather than un-plannable problems. Not at all cool options though but not impossible to decide which was clear for me after 6 months of ongoing Aerger. And so phantom pains are part of the hell "b" deal - overseeable, manageable, contained not as such but in relation to the previous situation. If I sit down to look for adequate visualization THAT is how it would look like:

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Crossing your arms to reduce pain [science put to work]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Crossing your arms to reduce pain [science put to work]; published May 28, 2011, 10:52; URL: https://www.swisswuff.ch/tech/?p=418.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Crossing your arms to reduce pain [science put to work]}}, month = {May},year = {2011}, url = {https://www.swisswuff.ch/tech/?p=418}}


When the brain is alerted of a signal that it would interpret as pain, peculiar motion patterns are set into effect - in other words, it makes us move in peculiar ways. That process allows it to localize and identify sources and localizations of pain. Then, the brain will be asserted and reassured that it has, indeed, found a proper localization or body site where it then will place the pain. From then on you will suffer pain that is assigned, by your brain, to that particular place on your body.

However, you may not want your brain to assign a place for pain.

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Phantom sensations, phantom pain - Vilayanur Ramachandran: A journey to the center of your mind

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Phantom sensations, phantom pain - Vilayanur Ramachandran: A journey to the center of your mind; published October 14, 2009, 00:34; URL: https://www.swisswuff.ch/tech/?p=226.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Phantom sensations, phantom pain - Vilayanur Ramachandran: A journey to the center of your mind}}, month = {October},year = {2009}, url = {https://www.swisswuff.ch/tech/?p=226}}


Vilayanur Ramachandran tells us what neurological observations can reveal about the connection between cerebral tissue and the mind, using three startling problems as examples.

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Synaesthetic sensations and pain after amputation

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Synaesthetic sensations and pain after amputation; published July 29, 2008, 07:19; URL: https://www.swisswuff.ch/tech/?p=206.

BibTeX: @MISC{schweitzer_wolf_1571329054, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Synaesthetic sensations and pain after amputation}}, month = {July},year = {2008}, url = {https://www.swisswuff.ch/tech/?p=206}}


Empathy and similar feelings can cause the feeling of phantom pain. I realize that I cringe and really suffer in situations that were no issue for me before the amputation. I am not bitter or frustrated at all - I physically suffer. I go through a bad time right then and right there. I suffer from seeing an ad with what looks like a prosthetic hand stating 'fake watches are for fake people'. I suffer when I watch the ridiculous amputation scenes in Peter Berg's Sony Pictures movie 'Hancock'. And it gives me a stab, or a jolt, when someone obsessed with ametolatistic paraphilia tells me my stump is to them just like a female breast to others. No offense meant - that physically hurts. I cringe, and I pain.

But I am not the only one.

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