Appearances and social effects are closely interlinked.

As one example, clothes have always had a major impact on social interactions. Read a good book if this is new to you. Along the same lines, even appearances of cars, computers, gadgets et cetera are often heavily discussed. Manufacturers spend a lot of money for looks of consumer goods.

If you want to buy a bicycle today, one selling point is the color being particularly robust – even though the frame cannot rust and the color is of really no practical use. So, appearances and social effects are a real thing these days. They create major ripples.

With that, re-enter the uncanny valley.

Appearances are the end-all-be-all for many aspects of prosthetic hands and arms. None of the recent products put forward by Fillauer (Taska Hand), Otto Bock (BeBionic), OpenBionics (Hero Arm) or Ossur (Touch Bionics, iLimb) have won the heart of the true user that applies the device for real work. And yet, their shape and appearance and even coloring schemes are what seems to move everyone, at least, if one believes the hype and the media.

At first, every now and then, or whenever, you just do not want to stand out as arm amputee, and, with that, you want to look and be enabled.

Appearance – looking inconspicuous, looking enabled – every now and so often were a prosthetic arm’s sole raison d’etre.

Also, and painfully so, that is where recent attempts at prosthetic hands and arms all die that sudden instantaneous all encompassing total death of utter failure. There is just no way to get this really right.

Of course, no one ever made an uncompromising attempt at building a realistically appearing prosthetic hand, but then, that problem is intractable. Read a good blog entry about prosthetic arm appearance testing, if that is new to you.

As appearance requirements for prosthetic hands, wrist and arms are massive in their impact overall, it pays well to now dedicate some more attention to this aspect rather than considering the big picture [link].

If you cannot get past getting the looks of your prosthetic arm right, you start out as the outcast, no matter what. You may not end up there but that is a bit of the problem – negotiating back “apparent” competence. Or, negotiating the uselessness of appearance as such, to “educate” the others about what is or is not going on.

And so from that moment on, the deck of cards is dealt in a totally different way.

Look at it like that: if I am already put into the awkward position to explain the ill disposition of my handicapped arm, total wreckage enabled hooks are a far better and plausible display of “enabled” than a high pitched stir of slowly animated fragile 70s B-movie appealing pansy boy hand.

That is, if I am already put into that awkward position to explain that.

Now, as we all know, the uncanny valley is a construct that explains how human likeness and repulsion or familiarity are linked. If that is new to you, there is a really great blog page about the Uncanny Valley to read about this.

So, what is new?

First of all, we can show where the difference is most marked, between self exaggerated positive body image (which includes the totally overpriced idiotic gadget that fails but exhilarates us) and detrimentally negative views of others that see the cripple, and maybe the crazy shine in their eyes, as well as the massively overpriced totally repulsive but hyped gadget that promises, never delivers, and nauseates ad nauseam.

I mean, I also totally love my own iLimb with all its problems and disadvantages – but that does not mean I am totally blind or stupid. That difference can be drawn up, between the various subjective feelings (red arrows, diagram A) and depicted alone (diagram B), and it becomes very clear that the pressure on people wearing such extremely “bionic” arms will systematically draw up tensions fields of large proportions. While a hook and Becker hand still may look a bit nutty but sympathetic, “bionic”  hands tend to look rather awful for others. And that will manifest itself no matter what. If ever the uncanny valley is correct in describing acceptance and repulsion, this is a model that also explains my anecdotal experiences with different prostheses. Contradiction free, actually.

If one now starts to walk along the axis of “human likeness” in both diagrams A and B, one starts at zero. One then will first come to an appearance quite unlike a real human. There, the bare arm stump resides, certainly it does not quite look very human as a whole wrist and hand part is missing (remember you the title of this website, do you not?). But seeing as if others are not rejecting that as much as oneself may (see diagram A, orange and purple lines) this can be dealt with over time. One gets used to it, really. After all, the problem really does not just go away as much as one, at first, may hope for that. A bit further up along the “human likeness” scale, prosthetic grippers or hooks reside. And while any of these really look more or less acceptable for most other people (black and purple lines, diagram A), that appearance by itself tends to give the wearer a very bad feeling (orange and green line, diagram A). So, the bare stump as well as technical looks may be good for well adapted, well greased, proud adult and matured arm amputees that know how little others really worry about that themselves, but these most certainly do not help a new amputee to feel great immediately. Functionally, hooks and grippers can be built to be part of very useful body powered prostheses, and running around without any prosthetic arm certainly works great and costs nothing – but just by themselves, they are not at all suited to make people feel great about their own disabled appearance.

If one then continues to walk along the axis of “human likeness” now towards the middle of diagrams A and B, there is a peak of the curves of others’ perceptions – the domain region of the Becker hand. The Becker hand is good for the amputee and looks great for others. Also that is a logical conclusion from applying the uncanny valley model to real world situations, and it matches my own anecdotal experiences. When covering a Becker hand with a skin like pinkish cover, one may be able to push its appearance to the actual dip termed the uncanny valley (diagram A, C or D), but for the most part and if ornamented wisely – see this blog about Red Hand, Becker Phantom Hand, etc. – , the Becker hand is a superbly made prosthetic device for both appearance to oneself as to others – not even mentioning its great function and affordable price. No one knows about it, but that is another subject.

If one then continues to walk further, to higher degrees of “human likeness”, then invariably one will drop deep into the uncanny valley itself (diagrams A through D). There, “bionic” drama prevails. Most “life like” hands there exhilarate, delude, seduce and convince the arm amputee that they in fact have a real goodie on their hand(s) – see green line in diagram A – but they are deluded and detached from reality as a comparison with the views of others – black and purple lines in diagram A – will illustrate. This means, that now, the amputee “objectively”  looks bad. No one would honestly admit that, I am sure – but I know what I feel, and from a number of trusted people I know what they feel. So again, the uncanny valley as a model logically leads us to that conclusion, and I would say it is confirmed by my own actual experiences.

As there are no current solutions to actually solve the uncanny valley problem, that seals it for the arm amputee. So, to summarize, the arm amputee may mostly hate their own bare stump and technical hook look, so life sucks for a while. And it may take quite a while for her or him to find out that current “bionic” solutions are by far worse, and until one found out that, life may just suck some more. A number of people may have no idea that they need to actively accept the fact their appearance is different, which can be achieved – but may require hard work, and also, they do not know the Becker hand. This leaves them with – nothing much in terms of positive development. Suicides and depressions may result, or a long agonizing attempt to obtain high tech implements that really do not provide functional improvement. A number of people wearing the absolute latest in technology, that may have spent dozens of thousands of bucks on high-tech (or got someone to spend it for them), neither look even a bit better because of it, nor did they avoid clinically relevant overuse of their (other, real, remaining) hand or arm. Not accepting that life sucks, not accepting that the other (remaining) hand and arm have their own limitations, not accepting that high tech will invariably push you down into the uncanny valley, all boil down to life being one continuous rage. That requires even more energy.

Now, in order to promise amputees, funding boards and their likes – usually one tends to be quite gullible, considering diagram B – all kinds of soothsayers, researchers and product managers of  prosthetic manufacturers will promise the arm amputee community any variation of “there is a tunnel, but there is light at the end of the tunnel”.

Usually, this promise is justified by vague hints at “research” (“a lot is being done these days”) or wrong analogies such as “who would have thought that we have planes one day”.  Or a departure from theoretically unbeatable hook concepts are encouraged actively: Otto Bock, for example, builds a particularly nasty variation of body powered arm componentry geared towards making the arm amputee suffer from their condition extra – with particularly stinky plastic for the harness, plastic cables that rip off ultra fast, useless cable cleats that work through any steel cable within days, as well as hooks and wrists that crap out so fast it makes your head spin. With that, they seem to suggest, that no one should suffer that type of prosthesis (diagram C, “hook”), sell them myoelectric technology (with that, however, you really get pushed inside the depicted tunnel, totally deep down inside the uncanny valley) and if anything, the promise is that the light at the end of the tunnel may come some time in the future (diagram C, “future”). And with that, they sell you socket technology [link], grip technology [link], batteries [link] and gloves at up to twice or three times the price of a car, or maybe at the price of an affordable house, whereas that prosthetic arm they sell you won’t even survive a car wash [link] and that even blocks or impedes your action if you want to bake a cake [link] – not that the underlying process is new [link] and not that actual performance would be obscure either [link].

That visionary image (diagram B, “light at end of tunnel”) however projects directly on the uncanny valley (see diagrams C and D) – and it now becomes interesting to more closely study this. Because that is where we are being had. That is where they pull us over the table. That is where they keep promising the blue off the sky against better knowledge.  Really, the tunnel tube object as drawn in diagram C is not a tube that ought to be positioned to illustrate “light at the end of the tunnel by virtue of technological improvement”. First of all, it is a kinked tunnel, and no light will get to the other side. It is a tunnel in which humans are stuck since around 1960, have been stuck for over half a century now. Which is when the questions focus on the sociologic aspects – as that stopped being a technical subject for a while now.

Really, the uncanny valley is the bottom of a deep dark pit from which current (and past) developments and research, particularly academic research, provide absolutely no escape. In it, “bionic” hands and arms reside and are locked. There is no solution to the appearance problem at all, nor is there a solution to energy source issues, nor are motors strong and light, nor is the socket and control issue solved, nor will we see usefully strong torques and infection risk free skin bolt interfaces in osseointegration. Nor anything. The constraints are too extreme.

Once you chose full robust action, the prosthesis will not look like a hand. Once you go for a “bionic” look, the hand will be hard to control and extremely fragile. Once you go for perfect nerve control with electrode implants and osseointegration, your ability for soft skin intimacy really walks out the door, and your thoughtless decisions to go for 8 swims a week in public pools are suddenly part of your future past and your new freedom becomes your new prison yet again.

The path towards really life-like appearance in any realistically useful fashion is technologically impossible. Hand transplants produce questionable results both appearance wise and functionally, not mentioning the considerable if not massive health risk associated with immunosuppression drugs and the absolutely back aching efforts necessary to at least try to bring these things to life. No one can hide their 7 kg of batteries – or it will be a great prosthetic hand that dies after 15 minutes of usage. If you still have any hope for your arm to pass as that, set the person up for appearance testing.

Really, nudging backwards, along the scale of “human likeness”, and developing actual mechanic, perfect robot cool looking truly mechanical hands or grippers are also not an acceptable proposition to the typical if not most “academic researchers”. It may be our most relevant hope as arm amputees but just that is the point: a good researcher will see it way under their dignity to serve an amputee, to serve a cripple, to deliver to what they have to believe to be a morally questionable individual – because in order to believe that restoring an amputated arm’s shape to its full hand containing outline really is what amputees need ever so badly in order to “get their life quality back”, one needs to dig into the belief that without the prosthetic arm, they are indeed identified as individuals of decreased moral status just as Erving Goffman remarked – and that includes also the notion of “slaves”, or lesser humans, or humans of lower rank. If one then considers Thorsten Veblen’s Theory of Leisure Class, one will easily see how actual needs of an arm amputee community is the last thing any half-ways self respecting academic researcher can ever want to address. How could we, the arm amputees, know better! How dare we! That would also mean that researchers would have to truly listen, to people they themselves must regard as sub-humans as that is what their own chosen path to “fix” them necessarily contains. They actually would have to feel. To empathize. Across their own deeply engrained belief that building yet another hand-like contraption is the way to go. On that way, a number of actually human aspects are conveniently forgotten, removed, taken away, dropped, omitted. And I can tell you for free that none so far passed my version of the Voight Kampff test.

So that is how it comes that in the year of 2014 (update: mid 2023), academic research into prosthetic hands is and has remained a dead horse, at a conceptual end. They will continue their empty heartless fireworks as long as gullible research boards throw money after them. Even considering the appearance-effect landscape, there is no real way out, conceptually. That does not mean they cannot have fun writing papers and such. But this means their excuse to “help”  arm amputees is definitely off the table, has been for over 50 years. I have to admit that took me a while to figure out. The uncanny valley provides an illustrative model to apply these considerations, in a way that own anecdotal evidence and experience fits well and without contradiction.

Of course, skin tight slip-free liners with regional myoelectric signal transduction that does not succumb to sweat induced signal deterioration, that successfully avoids electrochemical skin burns, with a usefully precise hand control that achieves < 0,03% error rate for real life daily use, with very light and long lasting power supplies, with robust and long lasting hand mechanisms, that provide actually reliable grips, as well as hand shapes that do fit standard industrial gloves rather than having to resort to proprietary gloves shapes, furthered by hand shapes that lack ridges or shapes that by design tear up gloves from their insides, all that combined with easy to use but smart software that takes myoelectric control to where we want it, would be game changers. But they are nowhere with these, never came close.

The problem, apparently, has been recognized by the companies that sell “bionic” hands.

Once these devices are sold for reasonable prices, with a technical or customized look and appearance, with good precision grips that actually work, with a halfway reasonable suspension and mostly a reliable control system approaching at the very least a <0,1% error rate for real use, then we may get closer to what the Becker hand already is and has been for over 50 years, and that is – in terms of the uncanny valley perception space – a relatively good place to be.

The path out, for the amputee, is to (a) accept that one is not the same any more and not wear the prosthetic arm until all feels well and good and sweet or until at least the world does not collapse any more on a minute-by-minute basis, (b) get a hook or gripper, get totally functional, and start building a really functional life, using whatever parts actually do the trick, and get a prosthetic arm build with designs and components that do hold up and do not fall apart, that are not build for obsolescence, thus also preventing overuse [link], then (c) maybe add a Becker hand just because it works so well and can be bought for a fair price (350 USD off manufacturer, 650 USD retail). If at all so much prosthetics is necessary. But to avoid overuse due to asymmetry, in the light of real work (physically demanding work) and repetitive real work, is worth the effort.

Sure, why not use myoelectric technology if it can be of any particular help – but be aware of the uncanny valley pitfall. If you handle that well, you are all set though.

This page bases on:

• my own wearing of a range of different devices
• my own talking to many other people about this
• other people showing their different range of devices
• talking and writing with other people about this

So it is a type of self-initiated user centered qualitative investigation.

Update 2023

It is interesting to see how my blog website here repeatedly inspires researchers.

After all, you read my ground breaking description of a discrepancy between own and other view on my prosthetic hand devices here first – simply because to come up with this, a fair degree of actual exposure to the subject matter – which in itself is to be regarded as privileged if not secret –  combined with a fair degree of critical reflection is required to come up with such.

Here is the research attempt in question:

Buckingham G, Parr J, Wood G, Day S, Chadwell A, Head J, Galpin A, Kenney L, Kyberd P, Gowen E, Poliakoff E. Upper-and lower-limb amputees show reduced levels of eeriness for images of prosthetic hands. Psychonomic Bulletin & Review. 2019 Aug 15;26:1295-302. The “uncanny phenomenon” describes the feeling of unease associated with seeing an image that is close to appearing human. Prosthetic hands in particular are well known to induce this effect. Little is known, however, about this phenomenon from the viewpoint of prosthesis users. We studied perceptions of eeriness and human-likeness for images of different types of mechanical, cosmetic, and anatomic hands in upper-limb prosthesis users (n=9), lower-limb prosthesis users (n=10), prosthetists (n=16), control participants with no prosthetic training (n=20), and control participants who were trained to use a myoelectric prosthetic hand simulator (n=23). Both the upper- and lower-limb prosthesis user groups showed a reduced uncanny phenomenon (i.e., significantly lower levels of eeriness) for cosmetic prosthetic hands compared to the other groups, with no concomitant reduction in how these stimuli were rated in terms of human-likeness. However, a similar effect was found neither for prosthetists with prolonged visual experience of prosthetic hands nor for the group with short-term training with the simulator. These findings in the prosthesis users therefore seem likely to be related to limb absence or prolonged experience with prostheses. [1] 

Their actual research premise:

“Despite these early suggestions, it is only recently that there have been empirical reports showing that participants rate lifelike prosthetic hands to be eerier than either mechanical hands or anatomic human hands (Poliakoff, Beach, Best, Howard, & Gowen, 2013; Poliakoff, O’Kane, Carefoot, Kyberd, & Gowen, 2018). Both of these studies, however, have been undertaken in populations without any significant experience of upper-limb prostheses (i.e., university students), and no empirical work has examined the degree to which prosthetic limb users experience this phenomenon.” [1] 

There are a number of interesting aspects:

• Again, still images: The authors [1] again only used still images and not actual prosthetic hands — as they did before; see other review here. One co-author of this study, Peter Kyberd, seems to be even one of the “masterminds” behind the Cybathlon [link], so what could possibly have gone wrong there ; ) All that innocent fun that can be had with unassuming arm amputees, right. As opposed to their first study, this time, for their still images, they used only black backgrounds – so it can be safely assumed they come to this website to read up on stuff.
• Again, lack of reference to this source: They claim that no empirical work was done, and yet, they come here to read up on stuff? Of course, empirical work as such has been done! Read this page : ) it is based on own experience, and on significant exchange over all things prosthetic with other people. It is quite empirical. It was here way before they wrote their paper.
• But, who is vulnerable? To know that arm amputees love their “bionic” hands far more than other people like them wearing these, is obviously not a thing that can only be found out in one way. While academic research has their “methodology”, as exemplified here, the things they do to uncover or document anything about what they believe constitutes a truth may be of very limited scope and success. More than anything else, in this fashion, we get a glimpse into the even darker valley than the Uncanny Valley: the dark gorges of true vulnerability. There, the obvious seems to be the obvious – as arm amputee, one is regarded as “vulnerable”, particularly by any academic research community. But is that so? Am I, are we, particularly vulnerable with regard to my, our, limb difference? Am I particularly vulnerable to have academic researchers surf in the wake of my ideas? What is the real problem here? Isn’t it that I am actually the privileged person in having the absolute front seat in a world of experiences, comprising also social as well as technical and physical realities, that are unattainable even for prosthetic technicians, leave alone academic researchers? Whereas their deep vulnerability lies in the fact that they are always late to the show, able to only feed on what is thrown at them? How can they ever be right? Why are they only using still images and not prosthetic hands in action? When I started to use prosthetic arm technology, it quickly dawned upon me that I had inherited a whole pile, a whole world actually, of problems left behind by my fellow arm amputees, almost none of which had tackled the technical issues that are, and were, relevant. So I quickly started to get realistic ideas about who was able to do, and, from that, see, recognize, understand, build, draft, test, relevant ideas and approaches – and far more importantly, who not. But that is not the path taken by these researchers. Now, it has been already stated elsewhere that “In this climate of global transition from neoliberalism to corporate authoritarianism (Giroux, 2002; Tierney, 2004), many academics are more vulnerable than before” [Jackson L. Reconsidering vulnerability in higher education. Tertiary Education and Management. 2018 Jul 3;24(3):232-41.] [2].  We then find that “the body has a material base that is shaped in a social context“[3] and from there, “illness as a biophysical state exists independently of human knowledge and evaluation, [but] illness as a social state is created and shaped by human knowledge and evaluation“[3]; accepting that the status of obsessively adhering to being an academic researcher in the way that a method actor goes by crawling deep inside the task of animating a metaphor, a role, “bringing it to life”, could be argued to have striking similarities to an illness shaped by researchers’ own knowledge and evaluation in that it is a chronic state that goes along with suffering[4], so it may provide insight to apply the same rules of vulnerability to these individuals. With that, it is 2023, and still, it is us, the arm amputees, the people with visible disability, disfigurement, and chronic pain, that also have to console and inform these individuals with the high claims, with mostly no thank you note and no references given. But, trust me, we know. They build their own prosthetic simulation arms because they do not easily get amputee subjects.

Ultimately, academia knows that “bionic” prosthetic hands are caught deep inside this Uncanny Valley. Reflecting observant amputees will know that, too. But who tells the other amputees that they are being had?

@article{buckingham2019upper,
  title={Upper-and lower-limb amputees show reduced levels of eeriness for images of prosthetic hands},
  author={Buckingham, Gavin and Parr, Johnny and Wood, Greg and Day, Sarah and Chadwell, Alix and Head, John and Galpin, Adam and Kenney, Laurence and Kyberd, Peter and Gowen, Emma and others},
  journal={Psychonomic Bulletin \& Review},
  volume={26},
  pages={1295--1302},
  year={2019},
  publisher={Springer}
}

@article{jackson2018reconsidering,
  title={Reconsidering vulnerability in higher education},
  author={Jackson, Liz},
  journal={Tertiary Education and Management},
  volume={24},
  number={3},
  pages={232--241},
  year={2018},
  publisher={Taylor \& Francis}
}

@article{wainwright2003reflections,
  title={Reflections on embodiment and vulnerability},
  author={Wainwright, Steven P and Turner, Bryan S},
  journal={Medical Humanities},
  volume={29},
  number={1},
  pages={4--7},
  year={2003},
  publisher={Institute of Medical Ethics}
}

@article{flegel2010take,
  title={Take back the meaning of term illness},
  author={Flegel, Ken},
  journal={CMAJ},
  volume={182},
  number={10},
  pages={E486--E486},
  year={2010},
  publisher={Can Med Assoc}
}