Prosthetic industry and academic research language grossly exaggerates to cover up absent technical progress [terminology review]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Prosthetic industry and academic research language grossly exaggerates to cover up absent technical progress [terminology review]; published April 15, 2010, 18:40; URL: https://www.swisswuff.ch/tech/?p=299.

BibTeX: @MISC{schweitzer_wolf_1561457278, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Prosthetic industry and academic research language grossly exaggerates to cover up absent technical progress [terminology review]}}, month = {April},year = {2010}, url = {https://www.swisswuff.ch/tech/?p=299}}

In prosthetic industry, language is often used in a wrong way. There are exaggerations as far as the eye reaches. Let us have a close look at what these exaggerations are. Secondly, amputees and media often use language in a similarly wrong way. Exaggerations as well.

Why all that drama?

Gross exaggerations with what appear to be clear terms

Let us first look at what the prosthetic industry exaggerates.

Term used What they describe with it What they should use
"Thought controlled prosthesis"

"Mind controlled prosthesis"

What they really talk about is myoelectric technology that was developed in the 1940s and 1950s.

"Thought controlled" or "mind controlled" clearly implies to be controlled by nothing else than by thought alone.

But in fact, we have to activate a peripheral nerve, then mostly wiggle a muscle, before the prosthesis has the slightest chance to move. As that really is no innovation in any sense of actual "thought control" or "mind control" at all, the language is in fact inflated.

A similarly stupid usage of "mind control" would be saying that my newspaper is delivered through "mind control". Sure, at one point in time my mind generates the wish to subscribe that newspaper. The ensuing non-thought-related but rather complicated events (i.e., the publisher takes down my address, sends me a bill, I pay that bill, then the newspaper has to be written up and printed, delivered to the mail boxes, etc.) illustrate ad nauseam that newspapers these days are not delivered by "mind control" either.

"Myoelectric prosthesis"
"Bionic prosthesis" What they really talk about is myoelectric technology that was developed in the 1940s and 1950s.

Bionic implies a bionic 'feel' (i.e., painless and seamless integration), bionic 'motion' (fluid, effortless, together with existing joints) as well as bionic 'degradation' (graceful decay of function rather than complete loss of function). Clearly, we are very far away from that. However, they lack innovation so they now proceed to call their stuff 'bionic'.

"Myoelectric prosthesis"
"Quality for life" What Otto Bock really talk about is a type of quality where cheap materials are sold expensively if not for absolute dream prices. "Mediocre material that stays in shape for a few weeks or months"
"Outdated technology from the civil war" What they really mean is cable controlled or body powered arms. Modern body powered arms offer unprecedented comfort and a care free quality of sensory feedback, grip precision and affordable pricing unreached by any other technology. However, companies cannot charge these completely shamelessly exaggerated prices they charge for myoelectric ('bionic', 'thought controlled') arms (see above) so their clear interest is to deter users from wearing body powered technology. "Body powered / cable controlled arms"
"Extreme usage" What they really refer to is normal usage. As prosthetic manufacturers sell you a lot of entirely ill fashioned and under dimensioned, small time tinkering constructions for dream prices, they have to make sure you don't get back to them through warranty. So they will declare any usage that damages their wares as 'extreme usage'. So, ironing, vauum cleaning, moving boxes or other stuff up to say 40 kg, doing garden work is 'extreme' in these people's diction. Obviously they are not of this world. If I use it, I use it and that is it. There is no extreme usage, all there is are crappy parts. "Normal usage"
"Independence from prosthetic technicians by getting osseointegrated" Osseointegration means getting a metal bolt to be invasively placed in the amputated bone end and stick out of the skin. It costs ~80'000$ to put it in, it takes a long time to heal, it may not heal and it always may get infected, and prosthetic parts remain as elusive as they ever were with the exception that instead of a socket, a connector has to be provided. All that costs extra. Health insurance is likely not to cover it unless there is a real reason to justify it. So in reality, aspects of independence massively decrease (choice of activities), others may increase (hopefully), and that for absolute dream prices. "Shifting and maybe increasing dependence at extreme financial expenses"
"Plastic stick with a hook on it" Really, Dean Kamen meant to say 'body powered arm'. His shameless attempt to promote his own stalled development that is almost as high tech as a Nintendo game station obviously ignores a number of things. First of all, a well designed socket of a body powered prosthesis can do entirely without electrodes. That means the skin of the stump is not locally indented, not locally compressed. Secondly, body powered arms do provide a bit of sensory feedback. Not a huge amount but enough to type without looking, enough to feel when one touches an object with a minimal push. Thirdly, my body powered arm runs 24/7 without any engineer on constant stand by. Fourthly, I am now wearing what is wrongly termed 'extreme usage parts' (see above). That means, my body powered arm can be - and as a matter of fact, was and is being - tuned to maximize performance. The current setup survives any bigger furniture or box moving activity. I wear modern materials precisely chosen for their particular role on my arm - Ramax holding steel, epoxy, carbon fiber, steel cables, Nokon or Shimano cable mounts, and so on. To call that "plastic stick with a hook" is a highly derogatory expression I do indentify as Dean's brain-depleted sales talk. There is a reason for someone to talk down on established technology such as this. Be aware. No good can come from this. "Body powered / cable controlled arms"

Let us now check at some wordings of current interest used by amputees or their family, or by media reporting. Hystery, exaggeration and grandiose wording is part of our lives on this side as well.

Term used What they describe with it What they should use
"I did survive the amputation". "Survival" An elective amputation could be seen as definitely more harmless than cutting tonsils, a thyroid operation or a Cesarean section. And as neither the operation nor the resulting disability poses any direct threat to life, survival skills are not at all necessary at any point ever. Patience, practice, training, communication skills, exercise, dealing with change - yes, those can come in handy. Admitted, there are tedious or boring situations, one is confused or discombobulated, things can feel a bit off, odd, weird, strange - but 'survival' is not a word that describes the situation. As far as I see it, there is nothing heroic about it. "I did manage to wait the whole thing out".
"You are an inspiration" Someone is said to "be an inspiration". That never sounds real, though. What I found when digging deeper it was more often that others meant they had to keep staring, for example. That then was worded as if there was an inspiration. But never did I experience that others figured to use that inspiration to actually do something different such as, say, 'better'. No - they just stared harder. "I gotta keep staring at you"
"I rather die than have an amputation" True, an amputation is a big thing - compared to a bugger in the nose. But no scientific method has proven limb preserving surgery to definitely result in a better life - pain, re-operations including risks, limited function, social issues, body image issues and financial issues are not necessarily better. So if you do weigh your options, dying should not be one of them. Particularly seeing as if (see above) 'surviving' an amputation requires similar skills to 'surviving' school: patience and exercise. Admitted, some decisions take a while and can be a real bitch. But dying? "Some decisions can be a real bitch"
"All it takes is determination - there is nothing I cannot do." Bollocks. Anyone that says that clearly lacks understanding of the real world right now and right here. Missing one hand, you can not play the flamenco guitar, do serious dangerous rock climbing, conduct difficult and narrow surgical operations, carrying very heavy objects and so on. Of course, many activities - taking garbage out, wearing a tie, brushing teeth or filling that water bottle everyone with a prosthetic arm all of a sudden 'is able' to fill - are easily performed one handed and without any prosthesis. Also, I can run up to a full performance but it comes with a price tag - I get overloaded and my intact arm will run into hand, elbow and shoulder problems. So not only am I restricted in my manual options, I also get to suffer strain from trying to deliver full performance. "There is nothing I cannot do" is a blatant lie. If you still doubt that, you may play Rachmaninov on a piano as an arm amputee and kindly report back to me. "I am seriously limited in what I can do and I do get to suffer from lack of balance and overload of the remaining limbs."

Why do prosthetic industry representatives do that?

Grossly exaggerated language is used to serve two means in prosthetic industry:

  • to shrink the perception of body powered / cable controlled technology to something that is unacceptable
  • to inflate the perception of myoelectric technology or osseointegration to something that everyone would want

As an example, Otto Bock representatives apparently were alleged to constantly nag users of body-powered technology as to their apparently outdated materials. Factually, they sell outdated technology (such as certain types of rechargeable batteries) for absolute dream prices.

Ultimately, results are these:

  • amputees are left with a lot less of insurance money
  • amputees are left with a lot less quality material
  • rather high rejection rate of arm prostheses
  • prosthetic industry thrives greatly

Example with itemized list

Also, initial body powered technology appears to be clearly designed to discourage users from using it:

  • Otto Bock aluminium hook jammed when warmed up > ~ 30 deg Celsius as in warm summers outdoors [1]
  • Otto Bock hooks contained in catalogs up to now have no cable ball bearing at all [1]
  • Otto Bock cables are by default Perlon cables that I ripped out after 2 minutes of usage [2]
  • Otto Bock steel cable cleats jam screw ends against steel cable wires which causes early damage [3]
  • Otto Bock Movowrist jammed irreversibly after minutes of using it [4]
  • Otto Bock standard wrist started to fail after a few months of using it [4]
  • Otto Bock 2-way hand irreversibly jams minutes into using it [1]
  • Otto Bock adapter bolts are so widely varying in diameter that their correct choice is a random experience [5]
  • Otto Bock shoulder harness plastic covers attract sweat so they smell really gory after a few hot days in summer [6]
  • Otto Bock cable housing curls up or jams rather fast [7]

None of that is necessary. For all of these issues, more affordable solutions dramatically improve the experience of wearing body powered technology.

Solution to itemized list

[1] I now use a V2P Prehensor, a Hosmer Dorrance 555 hook, Becker hands and for some situations, I have a Regal Prosthesis cosmetic glove fitted on an Otto Bock 1-way hand. I still have the Otto Bock hooks and I use them, but just not as often - as they are not built for 'extreme usage' ;) And I occasionally test and review my choices.

[2] I now use steel cable.

[3] Thanks to advice by the Brugg Drahtseil AG, I now wear correctly mounted steel cable.

[4] We designed and built our own wrist units.

[5] We designed and built our own wrist adapters too.

[6] I found out rather quickly that the most efficient fix was covering the harness using latex mountain bike tyre tubes.

[7] I redrafted and redesigned the whole Bowden cable issue.

For anyone out there, this means the following:

  • get smart regarding all of your technical options, get an overview over any product you may want
  • get smart regarding orthopedic technicians and exactly who offers exactly what - spending time with support groups may be a great way to find out others' indvidual experiences
  • don't ever accept foul excuses from prosthetic part manufacturers; get independent assessment and review before destroying faulty goods or before mailing it back to the manufacturer

Why do amputees, media or friends and relatives grossly exaggerate?

The reality is that of an unspectacular situation that is impractical to a variable and mostly context dependent degree. It may not even be worth mentioning, speaking of function alone. Apart from that, there can be a degree of nuisance as the daily upkeep tends to be a bit higher. The stump needs washing and skin care. The materials need cleaning and care. But then, so do my kitchen and bath room, laundry or garden. Some things are hard or impossible to do - but depending on the cause of the amputation that was the case also beforehand, you were in hospital or ill, you were battling chronic wound problems after illness or a violent cause. Sure, some people stare - but they are not my friends, nor will they be, so no big deal.

So really I get intrigued by these gross exaggerations. They are obviously provided for reasons. There is a fairy tale aspect being highlighted. Why call going through the whole ordeal "surviving"? Why not call it what it is - "waiting it out a difficult and boring period of adaptation"? Someone hiding behind that mountain of drama? What are they hiding? Someone trying to paint black and white? Why? Someone dramatizing to attract readers or viewers? Is that necessary? Why? What interests must one have to emphasize drama that much?

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