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BLUE LIGHT SPECIAL - defect iLimb glove poses tricky Catch-22 for Cybathlon 2020 [review]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - BLUE LIGHT SPECIAL - defect iLimb glove poses tricky Catch-22 for Cybathlon 2020 [review]; published April 21, 2019, 14:42; URL: https://www.swisswuff.ch/tech/?p=9987.

BibTeX: @MISC{schweitzer_wolf_1569096392, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - BLUE LIGHT SPECIAL - defect iLimb glove poses tricky Catch-22 for Cybathlon 2020 [review]}}, month = {April},year = {2019}, url = {https://www.swisswuff.ch/tech/?p=9987}}


The Cybathlon 2020 race rules confront us with two interesting Catch-22 aspects:

-hammering (if not other dangerous) activity that is not endorsed by "bionic" hand manufacturers [link]

-use of damaged / perforated covers, not endorsed by Ossur (see here)

The iLimb user / clinician manual clearly states "do not use without an approved cover", "do not use with a damaged cover", and, "damaged covers must be replaced by a qualified Touch Bionics technician or technical partner" 1.

However, the Cybathlon Karlsruhe 2019 footage clearly exhibits a torn and perforated glove (defect over the knuckle of finger II/index finger) being used during the competition during the task that has the competitor push a card into a slot.

From view of a user that had serious issues with these "glove covers" that Touch Bionics (then) / Ossur (now) sold for a premium, and who knows a lot about replacing these with better parts despite manual regulations, this is VERY interesting: because a damaged cover unnegotiably operates far outside the acceptable use condition that appears to be insurable. And insurance seems to be a thing there.

To remind you: Touch Bionics glove covers die by themselves when left alone [link] or when used for something as minor, uninteresting and light as a 10 minute car wash [link]. I was left to myself to identify a work glove [link] and a durable cosmetic glove [link].

The glove cover defect/s

(C) Copyright Cybathlon

(C) Copyright Cybathlon

Description of glove cover defect/s

See following image: there is an unambiguous perforation at A. B presents a small defect that seems likely perforated as well. Furthermore the location C may indicate an oblique perforation but not sure there. All together indicate force exerted with the back side of the hand against a hard structure which is very odd given the alleged / indicated competition history of the device in that specific context.

(C) Copyright Cybathlon

The Catch-22 with regard to glove cover defect/s

1 - Insurance is required for Cybathlon 2020 participation: from Discipline Registration Form for Teams Cybathlon 2020: "The registrant will be asked to submit further documents and forms to assure safety of the device and insurance of the technology provider and pilot". "Adequate proof of insurance for all team officials, namely against accidents, injuries, and personal liability. In any case, insurance is the team officials’ own responsibility. The team officials will be asked, onsite, to sign a registration sheet, including insurance statements. If that document is signed, the CYBATHLON organisers must and will assume that adequate insurance coverage has been obtained as requested." 2. The fine print is relevant as it is in the circus directors' interest to make sure their "tasks" can be legally insured and thus performed. All other is putting devices and people at risk.

2 - The iLimb must not be used with a perforated glove 3. With that, an iLimb that contains a perforated glove must not be used at all. It needs to be replaced at once.

3 - The prior competitive use in the "prosthetic arm race" at the Cybathlon does not at all suggest any use of extensor face / knuckle of hand for ANY activity at all4. So either a task was butchered, or, the glove was perforated already when the race started. Either of the two are unacceptable options for a scholarly investigation into an insured and academically supervised performance of grip pattern applications by a prosthetic hands for a decent public viewing.

3 - A perforated glove will invariably cause a STOP - a time-out, during which an in-race mechanic by Ossur - one of their qualified ones, not one of the unqualified Ossur mechanics whose speculative existence also is implied their user/ clinician manual - has to replace the damaged cover. Otherwise a situation arises that seems, in itself, impossible to insure!

4 - A realistic delay for getting a glove swapped by a "qualified" technician is about 1 (one) week! That will be the next available appointment, usually.

5 - At that moment, the participant loses a lot of time - so on legal and product claim grounds, any victory won with an uninsured prosthesis will clearly violate technical Cybathlon rules and risks to be revoked.

6 - The fact that this clearly is regarded as a total non-issue both by Ossur AND by the circus directors of Cybathlon opens a range of relevant questions with regard to the way they approach the subject in itself:

  • they probably do not know the meaning of an intact cover for any and every user; defective covers are a clear threat to the user5;
  • they probably do not know fragile covers to be "a thing" because they do not read up on relevant news and they do not understand technology; in the day of age of scientifically published facts also about this precise aspect link], this is somewhat hard to forgive;
  • when they cannot understand it, they will never ever be able to improve any aspect about it, clearly violating the top Cybathlon premise 6;
  • as the iLimb itself, the core build, is never really improved, improving its covers is indeed the only feasible way to really tune the device into better function given its shape and other limitations; that is why this is serious;
  • the iLimb was sold to me with the delivered promise by Touch Bionics via my prosthetist and a promise by representatives at trade shows that they wanted to sell better gloves, suited for better durability and work performance; and as we clearly have not seen ANY improvement in at least five years, are these suitable "advertising break" pictures? is that what they sell us as "engineering", as Swiss Federal Institute of Technology? Holes in the freaking glove covers?
  • they have absolutely no clue about the CE norm - not the circus directors of Cybathlon - they never stood out by overly investing into prosthetic arm know-how anyway [link] but also Ossur, which is more interesting [link].

Ossur is bound by CE legislation, so they can only advertise, or promote, or show as "fair use", anything that is within the actual performance limitations of their actually sold respective devices. That is why that high-level full circle type nonsense is actually hot.

Critical comment

If there was any plan of action here, I would suggest that the organizers think about assistive technology as something that has technical goals that are past the gadgetry and glitz and that are bare bones orthopedic and dermatologic (i.e, balance asymmetry without damaging the stump), and that costs a lot of money even when made from rather badly engineered parts, that is built for specific uses, that is often times not worth the money, and that is not at all easy to test. That particular combination of problems usually requires the technician and engineer to first develop a deep sense of respect - a thing that, for Cybathlon, has a very considerable space above, or in other words, there is a real lot of potential that is entirely untapped. So they could consider to work up, build, acquire or learn respect, before anything else.

The rest may follow, but the Cybathlon Gesture so far, if one euphemistically considers the Cybathlon attempts as a "gesture of academia", has shown that the mainly fruitless research in prosthetic arms - at least the ones ostensibly built for real work - so far has a rather traceable reason: lack of respect as clear explanation for lack of knowledge.

Other than that, testing individual performance of a prosthetic arm has to be job-/task-/work-/application specific and may actually not result in the same optimal result across individuals - as everyone knows since a long time now.

So it will come, the year 2020 ... and still, a well built performance tweaked body-powered prosthetic arm with a hook or gripper will be the only sustainable, comfortable durable build that can be worn for real work. Executive summary for Cybathlon 2016: premise failed. Cybathlon 2020: premise failed, with some Catch-22s as interesting confusion indicators but no improvements for real work anywhere around. That sure ain't technology.

Footnotes

  1. The user manual that is legally relevant for me is this one (reposted here for direct reference):

    (C) Copyright Touch Bionics

    i-limb ultra revolution clinician manual 12 23 14_0

  2. From the registration text:

    (c) Copyright Cybathlon

  3. The iLimb user / clinician manual clearly states "do not use without an approved cover", "do not use with a damaged cover", and, "damaged covers must be replaced by a qualified Touch Bionics technician or technical partner"The user manual that is legally relevant for me is this one (reposted here for direct reference):

    (C) Copyright Touch Bionics

    i-limb ultra revolution clinician manual 12 23 14_0

  4. From race rules of Cybathlon 2020: One slice of bread must be cut with the knife so that it is separated from the bread by falling off the loaf. Half a loaf is provided. A slice of approximately 20 mm of width needs to be cut on the cut side of the bread. The paper of the sugar cube has to be separated completely from the sugar. The lid of the jam jar has to be separated completely from the glass. If the glass breaks into pieces, the task is failed. The lid of the plastic bottle has to be separated completely from the bottle. The can top has to be completely removed from the can by using the can opener for left or for right hand use. The candle must be lit using a matchstick. Three matchsticks are provided. All objects must be placed on the table, i.e. if an object has fallen off the table before passing the start line of the next task, the task is failed. Hanging laundry requires a distinct set of fine motor skills, in particular of the fingers. For an arm prosthesis to be practical for daily use it must be possible to wear standard clothes with it. In this task, a hooded sweater must be taken from a coat rack, put on and the zipper must be closed. Clothes that are placed in a clothes hamper need to be hung up on a clothes line by using hangers and blue clothes pegs. Moreover, two buttons of a blazer need to be closed and shoes must be tied. The use of a hamper to transport the clothes closer to the clothes line is optional. The hooded sweater can be taken off again at the end of the task.The hooded sweater (size provided according to body size of the pilot) must be taken from the coat rack and put on correctly (i.e. arms inserted into the sleeves). The zipper must be closed at least to the mark. At the end of the task the hooded sweater must be hung on the clothes line or on the coat rack. The two buttons of the blazer need to be closed and the blazer hung on the clothes line using the hanger. The order of buttoning the blazer and hanging the blazer with the hanger on the rail is free. The shirt must be hung on the clothes line and attached with both blue clothespins. It is permitted to put the shirt over the line and then attach it with the blue clothespins. The shoe laces of both shoes must be tied together and the shoes must be hung over the clothes line (to proof that the knot holds). The type of knot is free. If any object (blazer, hooded sweater, shirt, hanger, shoes or blue clothespins) has fallen off the clothes line or the coat rack when passing the start line of the next task, the task is failed. The next task is solved once all blue objects are moved from their initial position on the table to their respective target position on the tower mounted on the table. It is not allowed to carry multiple objects at the same time (e.g. by stacking). The objects must be manipulated in the following order: 1. The pen must be inserted into the holder. 2. The plastic cup must be placed on the shelf above. If any of the red marbles drops out of the plastic cup, the task is failed. 3. The USB-Stick must be fully inserted into the socket 4. The rubber ball must be placed on the eye of the eyebolt. 5. The key must be hung on the hook using the key ring. 6. The coffee mug must be placed on the shelf. If any of the red marbles drops out of the coffee mug, the task is failed. 7. The credit card must be fully inserted into the card slot. 8. The DVD must be placed on the shelf above. The next task is solved once the following sub-tasks are completed a) Bulb lights up after it is screwed into the bulb holder. If the blue lightbulb breaks into pieces, the task is failed. b) The nail is driven into the wood using the hammer c) The paper is cut into two pieces within the marks using the scissors. It is only allowed to actuate (i.e. open and close) the scissors using the prosthetic hand. Thus, it is not allowed to assist actuation using other objects of the task (e.g. the nail, table etc.). The order and the number of tools and objects put into the toolbox are not restricted, i.e. it is permitted to carry multiple or single objects (in any order) to the table and walk only once or several times between the pegboard and the table, using the toolbox or not. It is allowed to grasp the plastic box with both hands to transport objects, including the blue objects. It is not allowed to pass the stairs to the left or to the right when going forth and back between the tables. - - (C) Copyright Cybathlon 
  5. To remind you: Touch Bionics glove covers die by themselves when left alone [link] or when used for something as minor, uninteresting and light as a 10 minute car wash [link]. I was left to myself to identify a work glove [link] and a durable cosmetic glove [link].
  6. Millions of people with disabilities use technical assistance systems in their everyday lives. These technologies often lack practical features, which disappoints users. This disappointment results from the fact that new technologies are either not being used and not even accepted in the first place. In addition barriers in the public environment often make the use of assistance technologies cumbersome or even impossible. Awoken by these observations the CYBATHLON aims to serve as a platform to drive forward research on assistance systems for everyday use, and to promote dialogue with the public. Technology developers should have the opportunity to exchange ideas and collaborate closely with people with physical disabilities as they develop their devices. Under the umbrella of the ETH Zurich, the CYBATHLON is run as a non-profit project, which aims to break down barriers between the public, people with disabilities and technology developers by organizing unique competitions. The competitions are organized as a public event. Goals of CYBATHLON: Promoting research, development and implementation of assistive technology for people with disabilities - Building a common platform for technology developers, people with disabilities, and the general public - Informing the public and stimulating discussion on inclusion and equality of people with disabilities in everyday life - Removing barriers between the general public, the users and the developers
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