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. 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 are a prosthetic arm's sole raison d'etre. Also, and painfully so, that is where 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].
Because if you cannot get 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. 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 - with 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 will say, that no one should suffer that type of prosthesis (diagram C, "hook"), sell them myoelectric technology (with that you 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 twice or three times the price of a car, at the price of an affordable house, that 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.
Really, the uncanny valley is the bottom of a deep dark pit from which current 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 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 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 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. On that way, a number of actually human aspects are forgotten, removed, taken away. 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, academic research into prosthetic hands is a dead horse, at a conceptual end. They will continue their empty heartless fireworks as long as gullible research boards throw money after them. But 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. 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, usefully precise hand control, very light and long lasting power supplies, robust and long lasting hand mechanism 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.
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 halfways reasonable suspension and mostly a reliable control system, then we may get close to what the Becker hand already is, and that is - in terms of the uncanny valley perception space - a 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, thus also preventing overuse [link], then (c) 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. 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.