Academic research dedicated to robotics and prosthetic hand development has failed to serve the community – for the last decades and without much exception. This is research that I started to see as sailing under The Amputee Excuse (TAE).

Specialists know that – since decades. Others such as researchers themselves may be still naive or misguided, but they should know. Why public financing is offered to such projects that have failed and will fail is not known. Really I don’t understand that.

But in principle, such robotic academic research that promotes the idea of prosthetic hands for researchers to write some papers and then ride off into career sunset never had the purpose to help anyone else. On paper, yes. But in real life and actions always louder than words, no.

Let us take a closer look.

NCCR Robotics [link]

The National Centre of Competence in Research (NCCR) Robotics is an SNF / Swiss National Foundation sponsored [link] nation-wide center consisting of research groups across Switzerland with the common objective of developing new, human-oriented robotic technology [blurb]. They are not well informed but well networked [myscience].

From the introduction:

In the near future, intelligent robots will play an important role in improving quality of life. For example, “care robots” will help elderly people to stay in their familiar surroundings longer; “neuroprosthetic” and “exoprosthetic” robots will increase the mobility and autonomy of people with disabilities; “educational robots” will support the training of a new generation of scientists and engineers; “environmental robots” will keep our world cleaner and safer.

This premise seems wrong, when looking at the puppies they aspire to put on the road vice versa real prosthetic arm requirements.

Their prosthetic hands probably weighs way over 4 kg. A recent figure that was named was 7 kg. A normal below elbow cannot even wear a 2,5 kg prosthetic arm all day without expecting serious shoulder and elbow problems after a few days, weeks, months or years – I mean, just wear a 2,5 kg wrist band on one arm, type a 10 page reply to this preposterous post and let me know what came of it.  My cosmetic arm weighs 650 grams, and even without prosthesis, I am quite functional and wear no additional weight. Unless the function of the hand or gripper allows for finding a particular pair of trunks inside a dark drawer, pull out a towel from a sports bag by recognizing its different texture and the like, I wonder what function they were dreaming about. If you cannot get the technical specs perfect, why even try about social aspects, right? Because don’t fool yourself – socially, prostheses are not a big help. As arm amputee, you get stared at no matter what. They made that 100% sure.

In fact, no Swiss National research project ever appears to have improved any arm amputees’ conditions on any industrial or general level anywhere. No Swiss academic robotic research – except a tiny number of industry sponsored specific tasks [1]  – has ever appears to have helped actual prostheses to actually get better in any tangible real everyday way. What defines what we get, today, tomorrow and a year from now, as arm amputees, are devices built after some older patented and outdated design ideas, whereas the technical implementation was not done well enough to hold up, for relatively high prices, with relatively uncomfortable aspects as to the way the components decay, degrade, come apart, fail or die.

The absence of any use, benefit or outcome of any such research is what I believe to be the precise reason why our current prosthetic arms appear so frustrating. In fact, prosthetic split hooks are the more modern design than hands.

As long as tax payers, Swiss National Foundation and other agencies keep not caring a bit about the impact of this allegedly “prosthetic” research, for all time and all future, amputees will have to put up with not only outdated and massively overpriced prostheses that are as dysfunctional as always – amputees will even have the Swiss National Foundation’s guarantee that no research will ever improve our situation as that money will be blow out straight through the chimney, from my point of view as person that has a disability everyday, now, tomorrow, in five years, in ten years, you name it. – Update 2021: it is ten years now, they have not moved a thing.

Furthermore, they write:

To smoothly transfer knowledge and technology to high-tech companies that can benefit from the NCCR research program, especially those with significant activities in Switzerland.

Funny.

Y’all realize we have had a few disability insurance (IV) revisions, and “paying more money” was institutionally and replaced with “paying less money” as part of a nation wide policy? Their goal seems to be, economically, that less people benefit, to a lesser degree. So, small companies capitalizing high tech junk that is non-functional dead weight in the proportions of 6 kg doesn’t seem to work, also economically – at least, on the planet that I am living on. — Update 2021: in the last >10 years, I did implement technical revisions that extend the longevity of my prosthetic arm past any commercially available intervals, and, at the same time, saving considerable financial, material and temporal resources. I wear a wrist unit that, when calculated over some four or six years, and a cable and shoulder anchor revision, that appear to save over 10 000 CHF for only a few years of use. The added sum that I save them is a lot higher. That all was our own, and to significant degree, my work, after I realized how “official” research and development is both unable to comprehend the constraints and requirements, as well as the concepts and technical design aspects necessary. 

Indeed, disabled people are mentioned nowhere among the education objectives (excerpt below) and quite frankly, why would you want to educate disabled people, amputees, cripples, about stuff you develop for them without even asking us beforehand?

Nothing about me without me. —Billingham, Valerie. Through the Patient’s Eyes. Salzburg Seminar Session 356, 1998.

So, you seem to know what is better for us without even asking us, us, that work hard and require to wear a prosthesis that holds up for real work? In fact, the somewhat androgynous unassumingly intelligent looking older gentlemen that are depicted in the NCCR Robotics website seem to have a different thing in mind, and that seem to be: young female students, and I would not even had guessed it, had they not put it there in clear writings:

Education objectives: The fascination of robots, coupled with the scientific, technological, and societal aspects that robots imply, offers a unique opportunity to attract and retain more students, to science and engineering, which have witnessed a constant decline over the past years. Indeed, robotics has some truly unique features to offer as a means to attract new students of both genders: it is accessible/understandable by a large public, it is interdisciplinary, it contributes both to science and to engineering, it teaches skills and know-how that are transferable to other fields, it is fun, it is popular in the mass media, it has societal impact, and it has important industrial and economical relevance. Based on our priorities and opportunities, our Education programs are targeted towards four specific goals: To increase the interest of teenagers in robotics­ related studies; To increase the number of students enrolling in robotics­ related curricula (BSc and MSc level); To increase number of students who enroll in PhD studies; To promote advancement of young researchers and women.

So far it was entirely new to me that prosthetic arms – technically a cumbersome, tedious and little comfortable subject – would be “fun” [see also Disability as Spectacle]. Next time I get a smelly skin rash under the prosthesis, next time a ripped cable tears up my shirt, I will try to remember that. — Update 2021: the Swiss NCCR Robotics, as far as we know, never developed better body-powered cable setups, and they sure as hell stayed away from smelly sweaty stinky stumps. Without any surprise, we had to do that ourselves as well. As that was clear from interacting with representatives of NCCR in 2011, I would still rate these interactions as “highly valuable” from view of myself as a user of a prosthetic arm.

If development of actually useful components for prosthetic arms was anywhere near popular, we’d also know that by now and there would probably be no need at all for this blog – but that type of research is not what is popular. What is popular seems to be hypes and unrealistic promises. Really useful parts are scattered far and wide. And even the hype loses attraction.

They don’t stop there, it goes on.

We will address the problem of reliable movement intention recognition from amputees’ residual EMG in amputees, by using information analysis techniques for better pattern discrimination and combining EEG and EMG signals to overcome the individual differences. We will also develop novel tendon-based actuation and soft tactile sensors for hand prosthetics, promoting the use of compliant mechanisms to improve the power density and adaptivity. Lastly, we will exploit the morphological and material properties (e.g. coupling through biomechanical constraints) to reduce the complexity of the control algorithm.

If anything that heavy and complex, that machine should take all of my individual differences into account and actually take advantage of them. Otherwise, this is a largely meaningless stream of buzz words. You should try to be a normal person and schlepp these 4-8 kg with you for 5 years or so (and 5 years, really, is short, unless that is when you finally develop something better).

Personally, I do not know of a single Swiss robotics researcher that wears a 4 kg wrist band on one arm but not the other, and if only just to investigate the actual effects of such a sucker arm on their own mood. Only then, of course, time will teach you that you will do anything to get rid of that sucker type arm as fast as ever possible and the last thing you will ever do is even pack more weight – such as wearing a hat for EEG electrodes. It is damage enough, to lack a part of an arm. No need to throw more ridicule after injury.

So to sum it up: the NCCR Robotics fails to provide tangible useful solutions for device suspension, body-powered lasting robust sturdy control, robust sturdy wrist connectors and robust sturdy grippers. As there is not more to it, they thus fail the subject in its entirety, as much as it relates to people that use a prosthetic arm for what I call real work.

Suggestion

Take a well built Hosmer split hook or Becker hand, Puppchen wrist, a highly optimized and well built cable control, new harness prototype and light socket, a stock Centri silicone glove and then assess base line grip performance over a range of ADL first to start off well.

Assess wear and tear of materials before anything else. What parts wear down? What parts need to be robust? What weight, what control strategies? Why don’t you pursue mechanical developments for body powered arms?

Assess strain and overuse. Check how the rest of the body fares. What about neck, spine, elbow, shoulder? What about the skin?

Paint a big blue spot into your face. Wear a really heavy hat with electrodes and cables sticking out. Ride the tram, walk the city, hang out downtown. Suck up the stares you get. Just start to walk in the shoes of someone you are going to hang with EEG, EMG and loads of gadgetry that may (or may not) work. Do that and see what you get out of it. Don’t do that for half an hour or a day. Do it for three months 18 hours a day and no single day of break – ride it out until you puke or want to end all of that at once, not every day but every minute of it. Then come back and re-read this text.

And before you get worked up over me being a bit blunt here – check out the AI lab of the University of Zurich. They [26/10/2011] neither seem to have hardware, nor test subjects, nor researchers, that work on that project and if they do they surely hide these well. No particular current research emphasis is listed at the Chair of Noninvasive Brain Interface at the EPF Lausanne either [26/10/2011] – no indication as to hardware as well.

From here it seems just like there’s simply nothing at all going on with respect to the advertising on NCCR Robotics.

DARPA [link]

The DARPA Defense Sciences Office with their Revolutionizing Prosthetics do not “revolutionize prosthetics”.

What they do is first and foremost belittle existing approaches. Then they exclusively research prosthetic arms for high level amputees – so of all the problems, they address one specific one. There appear to be no improvements for transradial or below elbow amputees being done there that result in tangible results. The Otto Bock Michelangelo hand, seemingly containing parts of such research, is for higher level amputees as well. Furthermore, they research ultra risky and expensive technology such as brain or nerve implants. While this all seems cool, it is the path of researchers that are extremely afraid of facing real users. They don’t build for application, not for shredding shrubs, not for riding mountain bikes. They do bot empower, not even with a fraction of their research money.

Their research is less beneficial for my current situation than the sale of sugar free chewing gum.

Smart Hand [link]

Here is what we learn from their “FAQ file” where we get a glimpse into the brains of the researchers:

Q: What type of hand prostheses are available today?

A: There are just a few types of hand prostheses available on the market today, most of them with very simple functions although there are also some technically quite advanced prostheses available. Most types can only open and close the hand on basis of EMG signals as described above. There are however several disadvantages with todays hand prostheses: they are heavy and they are difficult to keep clean. They can do only simple movements, they need power support from heavy batteries and they lack sensibility. Therefore many amputees prefer not to use their hand prostheses, but there is an ambititon [sic] and a general hope that better types will be available in the near future.

Awww. “Better types”. Is that right. These people forgot passive arms, the option of wearing no arm as all arms suck and of course body powered arms. With a carbon fiber arm and a Becker hand, performance is so good that these people don’t like it to the point where they do not even list it. It does wreck their pretentious justification. Besides, compared a metal hook or a well gloved Becker hand, there is absolutely nothing more difficult to keep clean than anything electronic. Why do you think is it that for really dirty work I am using my prosthetic hook rather than my stump?  Gosh, you really did your research well ; )

But, no, I cannot afford to entirely rely on ‘ambitition’ (of the above cited kind) or general hope.

The Smart Hand prosthesis could have major impacts on rehabilitation of amputates. People that have lived through a traumatic amputation often encounter sever [sic] depressions as a result of a distorted self-image and fear for social rejection. Further is it also common with phantom pains, forcing the amputee taking heavy painkillers and thus complicating a comeback to the labour market.

Depression results from pain, loss in its entire comprehensive quality (not just your gadget missing), from actual social rejection – not of fear of it, but of actual social rejection, overall downgrading of life as a whole. Working around depression of that nature does not require a prosthesis. Once one works around it, or even just halfways, or maybe a third of the way, one feels a lot better – regardless of a prosthetic arm. It’s a really long way. Christian Kandlbauer had been equipped with the most advanced prosthetic arms, thought controlled myoelectrodes after targeted reinnervation – and he killed himself. Get that: it’s not the gadget replacement that gets the amputee out of the depression.

And prostheses never work that way anyway. What planet are you living on. Prosthetic arms always – just as the naked or covered stump – label the outcast, show up the disabled, highlight the amputee. It’s not hard to realize that social rejection is not dependent on the prosthetic one wears.

Prosthetic arms also don’t deserve to carry the burden of responsibility for soul peace, for my mental sunshine. No commercially factory issued brand-component equipped prosthetic arm will survive my usage for more than 4-12 days anyway, and with that, one remembers that Thou Shalt Not Make Thee A Graven Image. Obviously blasphemic, Otto Bock named their latest attempt “Michelangelo” hand – but from amputee viewpoint, that is not a healthy approach.

And to see that one only needs to care, not even wear these. Without surprise, my friends and colleagues share their preference to rather equal parts for (a) stump without prosthesis on, (b) cosmetic arm, (c) bright red prosthetic hand, (d) metal hook, (e) black metal anchor hook (V2P). Some reject all of it, in any form. Many encourage me to get a Krukenberg split, a number of them do like technical looks rather than silicone re-enactments of previous anatomy.

Phantom pain is another problem, and probably not the leading reason why upper extremity amputees are unemployed. Depression, vocational issues or job situation generally are more likely reasons to consider. My phantom pains to a large degree depend on stump congestion. Nothing to do with nerve triggering. So I need a really narrow socket or compression socks – not electrode feedback.

Call to research review boards

• Research money granted under the label of “upper extremity prosthetic research” will have to undergo review from people that actually wear such arms. This is a strict requirement. That will save the embarrassment of reading post-hoc reviews such as here. Conversely, I will do what is required for pragmatic and result oriented development. If it means to roast projects after the fact, be it. Y’all could have asked here earlier. If it means to help out, answer questions, be it. But it is time this “label abuse” is brought to a halt.
• Amputee rehabilitation requires a strict focus on what works.
• Rehabilitation research must address what does not work.
• Problem areas are socket technologies, wrist units, cable control materials and set ups, terminal devices and sheaths / covers / gloves.
• Sockets should be comfortable and firm.
• Wrist units must release and lock fast, be light and service free, sturdy and small.
• Cable control must be precise and long lasting.
• Terminal devices must be light, offer a firm grip and be sturdy and long lasting.
• All parts must be serviceable and be able to be possibly repaired by orthopedic technicians.
• All parts should be of good quality in their final version.
• Fringe technology, gadgetry, should be avoided. No one wants non-functional gadgets except a very few eccentrics.

In the future, I will add more research projects as we go. I have also taken the liberty to actually look at published articles. And with “look at” I mean look at rather closely.

And yeah, this may be a bit heavy handed here, both literally and figure of speech. But are you a fair partner in terms of ethics? Do you regard amputees as an abstract cause, as idiots, as people not required personally for your crusade and actionism? And if yes (and those were rhetorical questions), why deep down and precisely do you believe an amputee should treat you differently?  As you probably forgot while you read this and you may have started to feel a tiny bit angry – this is a below elbow amputee blog, you intentionally clicked on it and navigated here, you are offered this information for free, and that is the rather unabashed opinion of an amputee who does deal with what y’all give a shit about, and who will defend that point of view rather upfront – as talking around aunt Katie’s house has brought us exactly where we are today: nowhere near where we want to be.

And so as always, we have to build the real shit ourselves. Being here, doing that. Just passed another technical eye of a needle last week.

@phdthesis{zlatnik1998intelligently,
  title={Intelligently controlled above knee prosthesis},
  author={Zlatnik, Daniel},
  year={1998},
 school={ETH Zuerich, Switzerland}
}