Prosthetic Aesthetics [fairytales, myths and hypes]

Science Gallery's HUMAN+ exhibition

Now, panelists - rather than journalists - accumulate to distribute fairytales, myths and hypes of tales unknown and terror that pertain to the wide and apparently foggy waters of subjects such as prosthetic arms, prosthetic bionic arms, prosthetic bionic hands, prosthetic devices as such, and not just as scope pertaining to the iLimb and iLimb pulse, but also to the Otto Bock Michelangelo hand, the BeBionic and BeBionic v2 hand, the new Vincent hand and other new "bionic" hands that may surface.

Proponents are Prof. Dr. Bertolt Meyer, Stelarc, Lizbeth Goodman and Rachel Armstrong. Host of the panel is Science Gallery director Michael John Gorman.

Here is the video:

http://www.youtube.com/watch?v=1wvWTlZYazw

Now, claims and assumptions range far and wide. Reality appeal appears to be in wider distance, not too close. We cannot cease to stare with disbelief. Yet, some artists seem to be able to save the day.

1) Bionic hand myth hype perpetuated once more

Myth: The iLimb (and some other models) are “bionic” hands that surpass anything that was beforehand. It is asserted that these hands are cool. They are portrayed as super functional whereas previous technology is not.

Fact: There currently are no “bionic” prosthetic hands. The term “bionic” contains a range of assertions that are not met by these models. Current prosthetic hands all look awkward. Some even sound weird. And a few cost a fortune without being any better in the two categories of dysfunction just mentioned. The iLimb or Michelangelo hand are simple myoelectric devices with very limited functionality. Given any particular task, there are other and far more simple devices that perform similarly or better. However, novelty seeking drives disenfranchised amputees into the open arms of prosthetic gagdet manufacturers. Novelty seeking can be problematic as such, and getting insurances to pay large sums of money to satisfy novelty seeking may just not be too adequate. What really is a problem is that individuals that lack self assertion hide behind brand names and established gadget names - such as "Ferrari", "Porsche", "Mercedes", "Michelangelo" and "iLimb". The problem is that hiding their vulnerable egos behind big brand names doesn't cure anything. It does not treat their limited self. Using big names as soul crutches is not a constructive way to heal.

iPulse beta tester / user Bertolt Meyer presents a distorted and biased view of upper extremity prosthetics. At first he claims that the iLimb hand “is the most advanced hand” ever built (0:04:33) - however, looking at durability, graded control  adaptive grip, battery free operation, sensory feedback and weight, cost as well as looks, that is quite clearly not the case. The iLimb hand is not advanced with regard to a whole number of rather relevant characteristics. The Becker hand is better, and thus, more advanced - with regard to a number of such characteristics. It may be older in terms of design, but it is a whole lot better with regard to a whole list of features. No wonder - as it survived countless improvement cycles. The Michelangelo hand looks a lot better in terms of proportions and wrist control - the semi-relaxed wrist is a superb feature that makes it far more advanced; thirdly, the Axon bus is definitely a step ahead in reducing interference issues. So actually, the iLimb is not at all the best prosthetic hand around as that is quite objectively an uninformed statement - the iLimb just so happens to be the prosthetic hand that Bertolt Meyer likes and advertises, nothing less and more. To give a fair appraisal of prosthetic hands is nothing he would be interested in. This, in this video, this is pure iLimb marketing talk.

Wrist rotation, and wrist connectors that allow for rotation, are a really old feature. I even have an outdated Otto Bock wrist at home which - due to being used rarely and well preserved - is in perfect working condition. Bertolt claims (0:09:50) that wrist rotation is a rather rare and new option for prosthetic arms. That is wrong. Wrist rotation, rotating quick connectors, are not at all new in prosthetic arms.

The iLimb discussed and shown here is, still and yet again, in no way “bionic”. The term “bionic” signifies, as mentioned many times before, a number of things, among other things it means that a very high degree of integration has been achieved. However, the iLimb, still and to this day, mostly sits at the end of a clunky myo arm with clunky myo electrodes and a clunky battery - just the way clunky myo arms were, since the fifties. Which means, forever.

Opposed to now seeing a “bionic” hand, we instead are faced with an extremely noisy clunky product as opposed to a more silent clunky thing - so acoustically, still also with the iLimb pulse, no further integration into the world of a real hand (doesn’t even squeak, such a real hand, ever paid attention?) has been achieved nor, as it appears, attempted. That doesn’t come as surprise as the Otto Bock Michelangelo hand also will stay proudly loud and noisy as proudly proclaimed by Otto Bock representatives. And then, the iLimb just as the rest of these prosthetic hands looks just as awkward as all the other prosthetic hands - stiff and clumsy, not a bit better than the World War II veterans’ hands they were wearing at the time (0:07:37). Also, the iLimb’s so-called technical glove cover neither hides its awkward shape or very loud noise. Seeing as if stiff awkward poses are a given for almost all prosthetic hands, one has to look past that to differentiate between aspects of prosthetic hand performance. Prosthetic hands indeed have advantages and problems - but no product available today comes even close in terms of being “bionic”. If you (like me) are privately stacking up savings to buy yourself a really cool bionic hand, now is the time to hold your horses. Now is the time to stay put. Neither iLimb, Michelangelo nor BeBionic currently is worth a tenth of the price they charge.

Prosthetic arms such as the myoelectric iLimb are best judged by people with motion and kinesthetically oriented talents and views - not by office workers that have a hard time connecting to their inner dancer. Lizbeth (0:22:20) details an obviously kinaesthetically talented amputee’s (Bobby Byrne) correct, precise and comprehensive description of a "bionic" arm: a current “bionic” arm is big, it is clunky, it is really ugly, it is hard to control, and it does not enable him to move or enable him to do the things he (actually) wants to do (such as dance). It has one role though - it shows him that (and how) other people care about him.

Learning to control a myoelectric hand usually is hard, cumbersome, difficult and frustrating. After years of trying, it eventually may become second nature or “proceduralized” (0:06:37) - but until that happens one will have to endure the heavy weight, limited reliability and absence of resources for other prosthetic parts indeed for “a couple of years” (0:06:55). In fact myoelectric control is error prone, difficult to master and not too reliable, fraught with delays and dependent on reasonably dry skin. Hence, these hands are neither brain controlled nor bionic.

2) The myth of prosthetic arms being a block between sensory world and function

Myth: People reject prosthetic arms because they cannot feel. They reject prosthetic arms because they do not allow an intimate relationship with the surrounding world.

Fact: As arm amputee, many people will reject you - as employee, as friend, as relative, as spouse - no matter what. My arm stump certainly feels but quite honestly, the two-point-discrimination is really bad. It is so bad that typing works mostly because of positional proprioception (not tactile). With the naked stump I can not find a light switch any better than with the prosthesis on (my prosthetic arm does transmit limited sensory information). The sensory feeling on my stump is not a particular help in the kitchen either. The stump skin is more sensitive and vulnerable than useful, if I was to evaluate its usefulness for full contact work. Conversely, my body powered arm protects the skin while not really diminishing the already poor sensory perception too much. Prosthetic arms are tools. They look conspicuous, unless they are well made cosmetic passive arms that are kept out of sight. Sensory feedback through prostheses is limited (body powered arms) or absent (myoelectric arms). Thus, functional arms - often not really very functional, relatively heavy, conspicuous - are mostly unpopular with amputees. Instead, many live without a functional prosthetic arm and only wear a passive arm on certain occasions (if at all). Also, body powered technology retains a high degree of popularity.

And then, having a relationship or relation to our humanity-enhancers is not restricted to prosthetic arms. Rachel (0:32:30) correctly points out that any technology such as cell phones can cause us to enter a relationship with technology. She assumes that tactile feedback is absent in prosthetic arms. What Rachel may not know any different, it is just Bertolt Meyer (and other myoelectric arm users) that lack such a high degree of tactile feedback. Undampened hard sockets, wrist connectors such as my Ramax hard holding steel wrist, and Becker hands or metal hooks, such as I, have absolutely no problem to do reasonably speedy blind typing, find light switches in the dark (with the prosthesis) and so on. If you exude and live motion and action, then obviously your prosthetic choice will reflect that. Obviously a stump does not have the same two-point discrimination as a finger tip but with that, I am well off with the body powered ultra hard and tight cable control. Besides, not wearing the prosthetic arm at all really is the way to go for sensations to the stump.

3) What a prosthetic arm should look like

Myth: a cool prosthetic arm has to look like an iLimb or Michelangelo hand. A factory issue coolness is always best. If the manufacturer does not sell it, you cannot have it. This is a closed world assumption. That’s how tunnel vision looks like.

Fact: a cool prosthetic limb can convey coolness through a very wide range of means. Manufacturers of prostheses are only one party that contributes to coll looks. I - myself - modified glove, covers, paint surface, appearance of my prosthetic arms and hands. My prosthetic technician was more than happy to help mixing colors into the carbon fiber or epoxy stuff he used on my sockets. Friends helped to sew, pick appearances they liked. There are professional prosthetic tattoo spray painters like Dan Horkey. Way to go, man, way to go.

Prosthetic hands should look socially acceptable and for some, that means “not medical”. Whatever that means is not entirely clear - given that any prosthetic arm is a non-licensed gadget built as cheaply as possible, sold for a maximum price, with absent state or insurance quality control - at least, in Switzerland. You can claim that your prosthesis is non-medical also by paying for it yourself, privately. But you have to do that first, before claiming a a non-medical nature. Looking at that gray whizzing stiff awkward looking iLimb gadget, it is not bad-ass or non-medical at all. Any old brown leather glove on a prosthetic hand looks more bad-ass and non-medical. Any naturally worn or repainted Becker hand looks more bad-ass and non-medical. Any hook looks more bad-ass and non-medical. I put red or other gloves on my Becker or Otto Bock hands, and that does not look medical. Even not wearing the prosthesis but just a muscle shirt is bad ass, and non-medical to the max. Whatever that means, non-medical. To me, skin colored PVC gloves - even when they deteriorate - do not look medical. They look “70’s B-movie-like”, they appear to me like cheap movie props. In my view, it requires extreme degree tunnel vision to say that the iLimb is the first prosthetic hand that manages to convey “cool” rather than “medical”. Or a contract that forces one to biased statements. But there are a number of looks I would try before spending 80’000 CHF and becoming a single branded gadget freak.

4) To recover from arm amputation, a prosthetic arm that replaces the shape and aspect ratio is required.

Myth: arm amputees heal from their disturbing experience (congenital or acquired loss) by replacing the limb.

Fact: arm amputees recover through a variety of means. Replacing the limb can be of help, but even there, one has to carefully weigh options.

Here, Bertolt Meyer appears to admit that he is a “gadget freak” (0:09:20) which seems to be what makes him wear that iLimb. He is not attempting statements about social disability, embedding function and integration, interactions on various levels and their meanings that go further than his own embodiment. Nothing wrong with that. But then, why is the famous gadget iLimb he wears gray? Why is it not yellow? Why is he wearing a checkerboard shirt? Why not wear something stylish? At any rate, it becomes clear that Bertolt attempts to restore his damaged self using an industrial metaphor - absent hand requires replacement of hand. And that is alright. Nothing wrong with an honestly declared preference and bias.

What counts for many other amputees rather than affordable, robust and cool prostheses are new ways of dealing with the situation. Replacing a hand may or may not be necessary - other issues may gain far more importance and weight.

Rachel addresses a very true and very relevant aspect in this panel discussion: (0:15:00) anatomical restoration based on a industrial model not necessarily succeeds - as in fact, since bodies and people are magical. The suicide of Christian Kandlbauer illustrates that - while having the most advanced prosthetic arms available far and wide, he committed suicide. - Over 50% of upper extremity amputees live without wearing a prosthetic arm - and quite obviously they somehow appear to manage. Functional integration, magical wholesomeness, happiness, social integration, using their minds rather than being and embodying a robotic prosthesis - that is what amputees really are about. Key is a plastic and curious mind, not a robotic arm. That is not  to say such an arm cannot have a part somewhere - but it should remain a part. Prosthetics is about aesthetic, and a good biography, it is about a good life. Obviously, seamlessly integrated and lifestyle adapted (body powered, cosmetic or myoelectric) arms and integrated lives are the key - not becoming a robot paradigm spokesman.

Lizbeth (0:39:10) states that social technologies, motion and kinaesthetics that allow amputees to emotionally heal can by far surpass the happiness attempted by mere gadgetry. I would fully support that view. Dance with yourself, take time to get into the new outline of your body. Allow for time. Allow for re-imagination. Play XBOX 360 with Kinect. Race butterfly just for the feel of it. Go back to finding your own new balance.

5) Transhumanist assumption - prosthetic hand better than real thing

Fact: prosthetic arms are light years away from performing like a real arm. Yet, some isolated points of performance can far surpass a real arm.

Myth: transhumanists hallucinate about prosthetic arms one day outperforming real arms. At the same time they do not see how current prostheses are already outperforming real hands or arms.

In this discussion it is stated that transhumanist issues contend, that a prosthetic device might actually be better than a real human hand (0:42:30). "Might"? Poof. Missed transhumanist moment.

First of all, there is an attitude problem. You cannot wear a prosthetic arm within limits of what, say, an Otto Bock’s warranty clause restrict you to. If you ever interacted with these guys - anything that exceeds their products very limited tolerances is - by their definition - "extreme sports". From my experience that includes household and garden work and regular job work. So to go along that line is utterly pointless and not constructive.

You must leave that range of inaction and go out there and really handle that reality. Prostheses are already better if at all one develops a master-slave relation with them and then uses them as the tools they were designed to be as well as off-label. Prosthetic arms are not be respected but used, and there is a difference.

Then, their already currently available transhumanist nature may quickly become apparent. Prosthetic devices already can be used to rip open envelopes and parcels, to grab hot or cold items, to expose them to sharp edges or to expose them to chemical or bio-hazardous chemicals. My prosthetic hook is extremely useful as the metal insensitive piece of equipment it is - to handle hot food like pizzas, oven trays, frying pans, boiling pasta, frying steaks. It is perfect to cut meat or vegetables and the hook does not suffer from getting cut - the blade just slides off it. Modest, but transhumanist.

6) Who be the test rabbits

Myth: prosthetic solutions that enter the market perform well and are for the privileged. They have been tested and worked out by test rabbits and now are super.

Fact: prosthetic solutions never perform before undergoing some 4-150 revision cycles. The people that work on revision cycles are the test rabbits.

Stelarc adequately points out that rich and apparently privileged people in need of new prostheses are not necessarily better off in terms of a good future as they also may be first in line if not vulnerable to new gadget type technology (0:45:00). Obviously this is correct as there is a lot of technical garbage packaged as "new technology". To discern that, not money, but factual insight is required.

A striking example is the Becker hand. As old as it appears to be, it has undergone steady improvement over the last ~ 70 years. Seventy years of revision cycles is extremely hard to top - so if Otto Bock’s Michelangelo or Touchbionics’ iLimb strives to be any better, they better round up all ultra critical and heavy users they can and then get these people to test, wreck, analyze and improve their stuff. That is the hard work required by them test rabbits.

I should know, I was test rabbit for a few prosthetic components myself.

The aspect of hooks and severed hands alerting deep seated fears and anxieties, and the aspect of that fear particularly affecting adolescent and pubescent children, seems to be relevant. This emerges also when carefully dissecting a recent design study. It thus seems to become a real question of just how the loss of part of an arm causes a throwback into a "body part restricted" type of body image problem just as experienced in puberty - and, how to mature and grow out of it again.

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Prosthetic Aesthetics [fairytales, myths and hypes]; published 02/07/2011, 12:46; URL: https://www.swisswuff.ch/tech/?p=448.

BibTeX: @MISC{schweitzer_wolf_1601469984, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Prosthetic Aesthetics [fairytales, myths and hypes]}}, month = {July},year = {2011}, url = {https://www.swisswuff.ch/tech/?p=448}}