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Disability and the public - prosthetic arms and more: do we appear "competent"? (review)

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Disability and the public - prosthetic arms and more: do we appear "competent"? (review); published December 7, 2018, 15:50; URL: https://www.swisswuff.ch/tech/?p=8812.

BibTeX: @MISC{schweitzer_wolf_1571589681, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Disability and the public - prosthetic arms and more: do we appear "competent"? (review)}}, month = {December},year = {2018}, url = {https://www.swisswuff.ch/tech/?p=8812}}


The current view of us, what the general public thinks of us, seems to be a major aspect. Of "us", yes.

The research question for this armchair analyst thus will be: are we - arm amputees in specific, and, as people with a visible physical handicap more generally, more broadly as disabled people generally, seen as competent people?

Generally, the answer seems to be a clear "NO" right from the outset.

This should not come as a shock. There are good reasons to believe that, great reasons to make that plausible, perfect reasons to justify that statement. With that, there may be exceptions to that -  people that see through society's fairytales of disability, horror and fears, but they are usually the exception.

As I had figured out quite early into my enquiries into that issue, that this aspect is of absolutely no further practical concern not because it is not disconcerting - but because I cannot change it. And that is a rapid, lean and cynical logical consequence, that I stopped caring about what other people think of me based on, say, visual impression of my prosthetic arm. I may thus safely focus on function and comfort, sustainability and cost, without worrying too much about whether other people treat me as more or less competent based on my looks. Not because it would not be cool to take influence but because it is of no matter as to the target dimension: the tendendy to disregard any mental capacity of people with physical handicap appears to be implemented in many people's thinking outside of any actual experiences. And regardless of what type of prosthesis I wear.

If anything, I might optimize my appearance by simply trying to look reasonably neat.

But to bend over backwards for what really we have to concede are actually strange people? If anything, can we hack their brains?

We are regarded as textbook examples of the permanently mentally incompetent: current authoritative view of research ethics in Zurich regarding the legal competence of disabled people

The current view of the people that authoritatively teach ethics in human research here of an authoritative body and unit for teaching research practices is, that a good example of a permanent absence to cognitive function is "disability" in exactly the words as shown in the following image that was taken off their presentation. Their view is backed by two large organisations.

There, the text reads (in German) "Forschung mit urteilsunfähigen Erwachsenen - Beispiele für dauerhaft urteilsunfähige Patienten: diese umfassen einerseits senile Patienten und andererseits behinderte Patienten". In English, we would translate this as "Research with adults lacking cognitive competence - Examples - patients permanently lacking cognitive function to contain both senile patients and disabled patients". Nowhere is the term "disability" explained further, or specified.

(C) Copyright (the authors) / CTC

I contacted the authors. I congratulated them for their balls, for their honesty, to voice such ubiquitous but politically questionable attitudes that clearly.

They confirmed this wording of their presentation, informing me that they believed that not only mental but also physical handicap also leads to permanent cognitive incompetence and there, they argued it would do so in so many cases that their presentation was correct as is, and that having "disability" written as blank cover category there was sufficiently precise in their overall context.

As far as I understood, people like me (i.e., with "disability"), were only meant as examples anyway.

Imagine you go to that course for good clinical research practice at that CTC there, for training, and imagine that you do not have any competent prior experience in treating, meeting or talking with people that have a disability.

Then, their presentation will be relevant news to you.

So, you may even write it down also in your notes: disabled people are good examples for people that are permanently unfit to judge.

One of the big questions that I had - just how do academics "know" that all disabled people by and large can "safely" be regarded as cognitively incompetent - is answered: that "knowledge" is ritually traded on, it is regularly spread, it is routinely disseminated.

That presentation, that course, and that slide going unquestioned, that is the mode of how these non-disabled people distribute their "knowledge". And, as we know so well, knowledge is power. That pertains also to the first derivative, here, this blog entry: I only know that because I was there.

And from that, we actually have to assume that people taking that course about how to structure research so it conforms to ethics and law regulations will note, write down, and memorize that a "disability" is an example for a condition that denotes the patient that is permanently incapable of cognitive or executive function. I have a disability, and so logically and conforming to the content of that slide being part of the official course teaching materials, I am "correctly" sorted into that category of patients at least from their angle.

After all, they are not at all, not a bit, not even minimally extreme, alone or abnormal. That still is what society thinks, let us not be fooled.

I have at least two own direct concise and immediate personal experiences, also around Zurich - one University of Zurich, one Federal Institute of Technology - , that clearly were in line with treating people with disability as generally incompetent.

  • A few years ago, I participated in prosthetic control research at a laboratory of the University of Zurich, as one participant, where my observations were not believed to a degree that it it became clear to me that they must think that I am unable to voice any symptoms correctly. Such as phantom pain, and its correlation with their test setup. Also they did not believe me when I told them my Becker hand was many times more reliable than their materials. They looked at my like I was from the moon.
  • I was contacted twice, by the organizers of the Cybathlon 2016 initiated by the Swiss Federal Institute of Technology in Zurich, to present my prosthetic hook (and myself) in their "old stuff" exhibition. They seemed to not respect the fact that we had a few brand new developments on my prosthetic arm, two of which with our own patents, which clearly would land me in the category of "ultra new and really robust prosthesis" rather than "old stuff". The ensuing discussion took about 45 minutes and resulted in absence of understanding on their part. Clearly, I must have been unable to understand technology.

And I am not posting this because it may be seen as outrageous.

I laughed when I saw that picture in their presentation. No tears were shed.

We are way past that. We really want to understand what happens in these other, so-called non-disabled people so we can hack their brains so they can view us as cognitively capable. That is what is behind all this at the current stage.

And while that seems to be clear mainstream in research law teaching here, it may be counterproductive also for the educated cynical utilitarist truly investigative researchers. That it is a blow in the face of a humanist amputee is a given, but as I said, we are way past that, we embody "who cares", we just leave a trail of ugly comments and that's it - but we now worry about society here, not me or other people with a disability. And so if anything is clear in terms of research and discovery, it is that none of these researchers ever came up with a really useful new prosthetic arm, or, a new part thereof, or, a new component. They did not build, or innovate, a single thing, and most definitely nothing that woud make me or any other person with disability look or act more competent. Their mostly subconscious labeling of all disabled people as broadly unfit to judge thus comes with a hefty price tag - that of missed innovation and that of uninformed research. They laugh off everything I say. They laugh off everything other amputees say. They laugh off this. Instead, they build crap.

As this is a wildly networked world nowadays, we have to assume they even consciously prefer that aspect over the acceptance of a far more nuanced reality of who is, or is not, in possession of cognitive capacity or executive function inasmuch as competence in a legal sense is concerned. And the reason why everyone misses out is because our views can matter. We can contribute - as people with disability. But we are probably not enough people that can contribute. We need the help of cognitively competent non-disabled people.

And believe it or not, one arm amputee (Bertolt Meyer) who does not seem to publish too many texts about hard testing or using prostheses for real work - i.e., digging holes with shovels, carrying very heavy weights, typing on industrial levels with regard to volume or speed - but who may be more into wearing iLimb products and who seems to have had or have a contract with Touch Bionics now came up with  a study where they found out that it really does not seem to matter what prosthesis one wears if one wants to appear comprehensively competent. Not sure the results hold up though. Let's review, shall we.

We are regarded as incompetent by the general public: what research knows about us and the general public

Handicapped people are thought to be less stable, weaker, less positive,less good, less motivated, and less happy than either "Me" or "People I Like". [1]

Handicapped persons are considered to be dirtier, less interesting, duller, more awkward, more foolish, more ugly, and less valuable than either "Me" or "People I Like. [1]

Handicapped persons are thought to be very unsociable, passive, and not free. Deaf, blind, amputee, and cerebral palsied persons are specifically characterized as soft, passive, and not free.[1]

"However, "Blind," "Deaf," and "Amputee" are considered braver than "Me". It is possible that this reflects a certain amount of admiration for someone who attempts to cope with a handicap through artificial means; blind persons use canes and seeing-eye dogs, deaf persons use hearing aids and learn to lip read, amputees master the use of artificial limbs. [1]

Summarized and quoted from [1]: It is suspected that a large part of the gap between normal and handicapped concepts is attributable to fear; fear of the incapacity the handicap represents and fear of not being able to cope with that incapacity in another person. One basis for the fear may be a perceived dangerous and/or overactive behavioral manifestation. Although the concept-specific factors in themselves account for a minority of the total concept, they may be the key which determines variations in the social acceptability of handicapped people. A great deal of additional research work is needed to determine what specific factors are involved in each handicapped person concept and to determine how these factors exert influence on the concept as a whole. Once this is done, ways may be developed to measure the effects of these minor factors on the concepts held by a given individual.

When measurement is possible, interaction training of the handicapped by a behavioral modification technique may follow.[1]

However, I find this intriguing: while the fears happen in the general public peoples, what do I need special behavioral modification training for? Wasn't it them that started to get all riled up?

We are regarded as incompetent by "bionic" arm aficionadoes when wearing a truly competent body powered TRS Prehensor arm: how competent can an amputee appear in the eyes of other amputees, when considering the option of (not) emulating a Cyborg, and what worth is that if the other amputees do not understand prosthetic technology?

First of all, the combined downgrading of mental capacities is similarly broadly attributed to both old and physically disabled people in a new study [2].

Read the study here (link / pdf).

Figure 1 of that study clearly jams the perceived high degree of warmth and relatively low amount of attributed competence of both old and physically disabled people closely together. We are nice but incompetent. The study based these results on an online survey, and while we cannot know who really answered there, this particular result - compared to the categorization from academic authorities, see above - is strikingly similar. Are online survey participants just as socially aware as  currently active researchers? What caused frenzy for the researchers, however, was the apparent coldness combined with relative (in)competence of Cyborgs: Bertolt worried that when wearing his iLimb, which appears to be a clear demonstration of his advertising contract with Ossur,

It is spooky in a way, as the authoritative legal ethics teachers in Zurich do exactly the same. A tiny difference is that this study calls old people "old people", whereas the professionals in Zurich used the word "senile"; the study here refers to us as "people with disabilities" whereas Zurich research ethics teachers call us "disabled people".

The rest of the study is quickly summarized: the authors presented their study population with three images and got it wrong in so many ways, you wonder what was going on. At the same time, their goal is entirely noble: if society does not help arm amputees dress up to look smart,  which includes directives as to how to dress up the hosed arm(s), we need to find our own ways to dress up so we look smart. And while they did not word out that goal in these words, that at least was the ulterior motive I read into this ill fated attempt to attribute visual competence to prosthetic arm variations.

Can we establish actual competence of an arm amputee by looking at his prosthetic arm? Without asking questions, just by looking?

While people do infer cues for their assumed competence for others by looking, we all know that this is non-sensical. You can not really establish reliable markers for smartness by looking. Exactly that is the problem that fuels IQ testing: that you can not infer mental competence from just staring, inspecting, watching, looking.

 

Body powered arm: "Bob Radocy wears a body powered arm that restores little functionality"

The first image was one that the authors called "prosthesis of little functionality" and it was this image, which Bertolt Meyer obviously found appropriate to subtitle with the sentence "He is missing an arm and wears a body-powered prosthesis that restores little functionality in comparison with average able-bodied individuals".

This is somewhat inappropriate if not outright funny because Bob Radocy (who is in that image) invented, built and wore the Evolution 5 Prehensor to win the Cybathlon 2016 arm race against all "bionic arm" competitors.

The TRS Prehensor models are the only grippers that go to the far out extreme in actual performance levels, way beyond what the iLimb-type of "bionic" componentry delivers. A TRS Prehensor is controlled by a very reliable system (body power, not myoelectric), and it allows for a very subtle grading of grip powers along a very wide scale. If you wear it, you have perfect sensory feedback for the grip force.

(C) Copyright Bob Radocy / Cybathlon

The second image was the one below, shows Danny Letain of a Canadian team, subtitled with the text "The person on the following image has a physical disability: He is missing an arm and wears a bionic hand prosthesis that restores a fair amount of functionality in comparison with average able-bodied individuals". This is technically absurd, in that this pilot of the 2016 Cybathlon shown here clearly had a functional drop out of his arm mid race and lost all function mostly due to the way this "bionic" arm is built, functions and usually drops out working - i.e., sweat levels make myoelectrodes stop working.

(C) Copyright Danny Letain / Cybathlon

The third image was used by the authors was subtitled "The person on the following image has a physical disability: [He is quadriplegic and uses an exoskeleton/He is missing an arm and wears a bionic prosthesis/He is missing both lower legs and wears bionic leg prostheses] that restore[s] functionality beyond the functions that average able-bodied individuals posses." This is interesting also because the arm shown here was never built for actual high functionality. Instead, it was a beautiful showcase for

(C) Copyright James Young

As a result, asking 87 people, they visually appreciated "competence" virtually the same - not perfect - for all three.They all were less than competent. The three appraisal averages were statistically not of significant difference, all the while the authors tried to milk an insufficient p value for "marginal significance".

Ultimately, arm amputees that wear a bionic arm rather than a prosthesis that appears to be of a less functional or technical appearance do not differently impact a probably non-disabled audience. In other words, the actual visual presentation of an arm amputee seems to cause them to assume a reduced general cognitive competence no matter what.

Scientifically, the comparison is not well performed. First of all, we know that assumed cognitive competence is translated into a whole bunch of visuals.

  • A dark but not pitch black background is a lot less ideal to convey competence than a white or fully black one [3]. So please use a white glove for your "bionic" hand, some subtle perfectly resolved Arctic shading, and a white background. Only this will persuade anyone that the prosthesis that is shown is true, totally functional and superbly competent. People do not know anyway, so why not get them where you want them using the old concept of fluency. To make sure we are all fair and nice, the same other variables will be constant through all images being compared. Obviously ; )
  • If one guy gets to stand there with his naked belly out, all should. Or in other words: the cyborg class of prosthetic exaggeration certainly lost points because the authors of the study thought everyone else was focused on the arm, and only on the arm, whereas anyone normal will see the whole picture always [4]. Which, here, conveys mixed feelings. The poor guy could have worn a dress shirt, and firmly looked into the camera, squinting. Actually all three of them [4].
  • Transparent temporary sockets never look competent. If your arm has its innards showing as the one Dennis Letain got to wear at the Cybathlon, everyone can assume that this technology is not mature. At least, no true Cyborg could have validated that image choice - if anything, this is the most Cyborg of all prostheses as apparently it even had sensory feedback at some point in time.
  • Never show grown up men in boys' clothing if you are after visual competence [4]. Bob Radocy is by far the most (manually) competent arm amputee of the three, also given his top of the line prosthesis - but his true handicap, visually, here, in the context of getting judged by any people of Germany for a psychology paper, is that he wears a slack sports style polo shirt, chews gum, and tries to compete rather than looking top level Bertolt Meyer style dress code sharp. And that, my dearest of friends, is a handicap, one for visual competence.
  • The authors even tried to trick age as factor into their image sequence. This is intelligent if you want to go unnoticed by biasing the audience but a bit dumb if you get caught doing so. Well, read Figure 1 again and swallow that one.

Having uncontrolled and provenly relevant variables going astray, here, we can safely conclude that also that does not matter. The arms were chosen with wrong subtitles, and the image sub basis narratives are a mess. The image sequence chosen here shows bad judgement and certainly an arrogant attitude towards true high tech, which obviously is body powered TRS Prehensor based gripper power. What a shame.

Fact 1: body powered arms are by far the best choice if you want to perform real work competently

Not only is the Cybathlon 2016 a good example of just how things tend to go with prosthetic application for academics that usually seem to have a very hard time understanding aspects of real prosthetic arm use. Also, real work application of technology usually results in hard results that are not negotiable so much.

Clearly, any psychology study wanting to know how relative, visually assessed and assumed competence of a prosthetic arm user looks like in real life, should have compared video sequences of the following entirely realistic scenarios:

  • the visual impact of an iLimb after two hours of wearing a hot sweaty overall, with three more hours to go, with heavy lifting going on as described in [5]
  • the visual impact of a body powered hook or prehensor device after two hours of wearing a hot sweaty overall, with three more hours to go, with heavy lifting going on as described in [5]

The fact that authors of psychology studies such as the one cited and reviewed above, or the general public, has no idea about these realities, have absolutely no impact on the actual issues related to prosthetic control - have not had any, do not have any, and will not have any.

Fact 2: "bionic" arms are often in the way, so they may pose a greater reduction of manual competence than not wearing any prosthesis

"Bionic" hands are great for experimenting inside the meaning space of rubber hands. They are great to explore the myoelectric promise. They are fabulous for posing in any context - such as presentations or cosplay events. There, visual competence can be assessed as well, for whole body masks.

Fact 3: how to really look smart has nothing to do with the prosthesis one wears

From these sources:

  • https://www.wikihow.com/Act-and-Look-Smart
  • https://www.realmenrealstyle.com/look-smarter-fast/

The rules are clear for visual appearances:

  • Presenting Yourself in a Smart Manner - take a digital photo of yourself each day in your different outfits, evaluate your clothes. Start adding smart looking pieces to your wardrobe.
  • Dress athletically only when in use. Men and women should avoid wearing athletic attire and shoes unless you are actually doing something athletic.
  • Wear shoes that are undamaged (free of deep scuffs and wear), that fit well and that can be polished (unless suede).
  • Pay close attention to personal hygiene.
  • Wear quality eye-wear. Glasses are a commitment. Instead of getting contacts and fake glasses just don't get the contacts. Go with glasses for the most studious look.
  • Maintain Appropriate Eye Contact.
  • Wear Glasses.
  • Smell Pleasant.
    • Wear cologne – it should be discovered not announced.
    • Bathe in fragrant body wash – one that lingers a little bit.
    • Use body spray – bonus if it's the same scent as your body wash.
  • Wear Well-fitted Authority Uniform.
    • Sport a stiff and neat collar – it balances the face and looks proportionate.
    • Opt for neutrals – this is more useful at work as a lot of bright colors can be distracting.
    • Use a blazer or a jacket when possible – The square shoulders signify strength and the tailored body implies discipline and demands respect.
    • Polish your shoes – shows that you pay attention to detail.
  • Wear a Bit of Red.
  • Leverage the Latest Technology.
    • Cutting edge and innovative.
    • Resourceful.
    • Futuristic.
    • Organized.

Summary

The fact that there are loud, dominant and academically appearing voices that totally warp realities of prosthetic arm perception against true function does not impact the one relevant fact:

  • That body powered arms are still by far the best if not only viable technology for the demanding user, that is, a user that regularly delivers real work.

I had started to point out, after Cybathlon 2016, what detailed control and grip problems Touch Bionics and their iLimb had. The individuals of Touch Bionics, that participated as pilots in the Cybathlon 2016, and that so far had held workshops here and blathered about just how reliable this and that was, knew that I had asked these exact same questions to their customer service already three years ago or so. So when I pointed out that they, themselves, were just as unable to overcome these obstacles as I had been, they unfriended me on Facebook : ) Which is funny as the only goal here can be to improve the way these prostheses work. They cost far too much for the company and their esteemed employees to not invest their all into solving these problems. So, with this article, the attempts to solve grip and control problems by portrayal of TRS Prehensor as incompetent appears to be their only incentive, while Touch Bionics keeps lacking better engineering.

[1] C. J. Jensema and L. M. Shears, "Similarity of Factorial Composition of Normal and Handicapped Person Concepts.," , 1970.
[Bibtex]
@article{jensema1970similarity,
  title={Similarity of Factorial Composition of Normal and Handicapped Person Concepts.},
  author={Jensema, Carl J and Shears, Loyda M},
  year={1970},
  publisher={ERIC}
}
[2] [doi] B. Meyer and F. Asbrock, "Disabled or Cyborg? How Bionics Affect Stereotypes Toward People With Physical Disabilities," Frontiers in Psychology, vol. 9, p. 2251, 2018.
[Bibtex]
@ARTICLE{meyerb2018cyborg,  
AUTHOR={Meyer, Bertolt and Asbrock, Frank},      
TITLE={Disabled or Cyborg? How Bionics Affect Stereotypes Toward People With Physical Disabilities},        
JOURNAL={Frontiers in Psychology},        
VOLUME={9},      
PAGES={2251},       
YEAR={2018},          
URL={https://www.frontiersin.org/article/10.3389/fpsyg.2018.02251},   
DOI={10.3389/fpsyg.2018.02251},       
ISSN={1664-1078},      
ABSTRACT={According to the Stereotype Content Model that construes attributions of warmth and competence as the core dimensions of stereotypes, people with physical disabilities are generally perceived as warm-but-incompetent, i.e., are faced with paternalistic stereotypes. We argue that the increasing proliferation of bionic technologies (e.g., bionic arm and leg prostheses, exo-skeletons, retina implants, etc.) has the potential to change stereotypes towards people with physical disabilities: The portrayal of people who use such devices in the media and popular culture is typically characterized by portraying them as competent - sometimes even more competent than able-bodied individuals. We thus propose that people with physical disabilities who use bionic prostheses are perceived as more competent than people with physical disabilities in general. We also propose that they can be seen as more competent than able-bodied individuals. We further propose that this increase in perceived competence may be associated with a decrease in warmth such that people who use bionic prostheses are perceived as less warm than people with physical disabilities in general and as able-bodied people. Based on labeling theory, we also propose that using the label "cyborg" for people who use bionic prostheses exacerbates these effects and that they are driven by the technicality of the bionic devices. The first of two online studies (n = 314) revealed mixed support for the hypotheses: People with physical disabilities who use bionic prostheses are seen as more competent than people with physical disabilities in general, but not as more competent than able-bodied individuals. They are perceived as even warmer than able-bodied individuals. On the contrary, cyborgs were perceived as competent-but cold, i.e., as threatening. With the second study (n = 87), we tested whether the perceived technicality of bionic technology drives some of the observed effects. Technicality only had marginal effects on competence perceptions and no effects on perceptions of warmth. We discuss potential implications and highlight that despite being somewhat mixed, these findings show that technology can affect stereotypes and interpersonal perceptions.}
}
[3] R. Reber, P. Winkielman, and N. Schwarz, "Effects of perceptual fluency on affective judgments," Psychological science, vol. 9, iss. 1, pp. 45-48, 1998.
[Bibtex]
@article{reber1998effects,
  title={Effects of perceptual fluency on affective judgments},
  author={Reber, Rolf and Winkielman, Piotr and Schwarz, Norbert},
  journal={Psychological science},
  volume={9},
  number={1},
  pages={45--48},
  year={1998},
  publisher={SAGE Publications Sage CA: Los Angeles, CA}
}
[4] D. S. Sundaram and C. Webster, "The role of nonverbal communication in service encounters," Journal of Services Marketing, vol. 14, iss. 5, pp. 378-391, 2000.
[Bibtex]
@article{sundaram2000role,
  title={The role of nonverbal communication in service encounters},
  author={Sundaram, Dilip S and Webster, Cynthia},
  journal={Journal of Services Marketing},
  volume={14},
  number={5},
  pages={378--391},
  year={2000},
  publisher={MCB UP Ltd}
}
[5] W. Schweitzer, M. J. Thali, and D. Egger, "Case-study of a user-driven prosthetic arm design: bionic hand versus customized body-powered technology in a highly demanding work environment," Journal of Neuroengineering and Rehabilitation, vol. 15, iss. 1, p. 1, 2018.
[Bibtex]
@article{schweitzer2018casestudyprostheticarm,
  title={Case-study of a user-driven prosthetic arm design: bionic hand versus customized body-powered technology in a highly demanding work environment},
  author={Schweitzer, Wolf and Thali, Michael J and Egger, David},
  journal={Journal of Neuroengineering and Rehabilitation},
  volume={15},
  number={1},
  pages={1},
  year={2018},
  publisher={BioMed Central}
}
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