I was fortunate enough to get the opportunity to go to Leipzig, Germany a few weeks ago for the OTWorld 2016 Convention, which is an international showcase for the latest in orthopedic technology, prosthetics, myoelectric/bionic limb tech, etc. It was a dream come true. Futuristic mechanical limbs and realistic silicone prosthetic covers as far as the eye could see, all being worn and displayed by amputee models! It was incredible.
The options available for amputees ranges from the purely aesthetic to the highly functional, with offerings from a lot of heavy-hitters in the world of orthopedics. Touchbionics (Ossur), Bebionic (Steeper Group), Vincent, and Ottobock all had extremely nice, sleek myoelectric / bionic hand options, with models showing their functionality and various grip patterns. The tech in these hands is improving exponentially, making them smaller and lighter weight, with more functions and faster response time.
I spend the majority of my time as an anaplastologist making realistic silicone covers for prosthetic limbs (also called a "cosmesis - cometic + prosthesis). I work one-on-one with patients in order to accurately match the shape of their prosthesis to their own anatomy, as well as creating accurate textures and matching colors to their skin tones. At the convention, there were several companies offering very detailed and well-made prosthetic covers, and this was awesome to see. I spoke with a lot of technicians who work on these types of prostheses and I learned a lot of really great information and different techniques. Each group makes their silicone covers in a slightly different way, so having the opportunity to speak with others in the field was an invaluable experience. My personal favorites came from Dorset Orthopaedic (Ottobock), which is based out of the UK. Not only are their sculpts very nice anatomically (thin ankles, realistic toes, prominent vasculature), but their colors are spot on. The variation in color and freckle patterns was really impressive to see up close.
Aside from rubbing elbows with other people in the industry, I went with the company I work for to launch and promote a new prosthetic technology that we have been developing: the CLICK-ON modular arm prosthesis. Over the past few months I have been working with a small team doing research and development for this new, patient-specific, customizable prosthesis. With this system, the patient is fitted with a custom silicone liner for their stump and a socket with a carbon tube structure, which allows a prosthetic hand and "click-on" armatures (that mimic the shape of their arm anatomy) to be attached to the structure. Here is a short demo video showing the various components being attached and swapped out:
The major perks of the CLICK-ON (aside from being a perfect match of the opposite arm, anatomically) are that each component is completely customizable and extremely easy to change out without needing tools. The hand, the radial click-on, and the ulnar click-on can all be designed to the patient's specifications, and come in a variety of different colors and materials. The hand is designed after a digitally scanned, mirrored, and printed copy of their opposite hand, then sculpted in silicone to mimic their other hand, either realistically or in a solid color of their choosing. Each hand is also designed in a standard pinch position so that they are able to have basic functionality with their prosthesis. The click-ons can be a solid 3D printed material, silicone, leather, carbon fiber, etc. Once the base model has been designed for the patient, they can acquire new components in different styles and colors, allowing them to quickly and easily switch between different combinations to suit the occasion. Additionally, we are developing accessories that can be added in place of the hand using the same mechanism, such as a utensil holder and an attachment for bicycle handles.
It was a really spectacular experience - an amazing hub of innovation and spectacle! And it was also very exciting and rewarding to see the CLICK-ON amongst the options available at such a prestigious convention. Here are a few more pictures from the event (in no particular order):
Now to get back to the Uncanny Valley. There are differing opinions about what type of prosthesis a patient should get, and obviously a lot of it depends on what the patient hopes to get our of their prosthesis. The spectrum ranges from less functional and highly realistic (cosmesis), to highly functional and less realistic (myoelectric). In general, the more functionality that a prosthesis has, the less realistic it has to be, due to the requirements and constraints of the mechanics of the hand. Realistic silicone covers work on prostheses with minimal functionality because they have fewer moving parts, and there is less wear and tear on the silicone. In order to make something that will work on a bionic hand and bend and flex correctly, you need to use a softer, less durable silicone, which will be prone to tearing, discoloration, and a whole host of concerns. Nonetheless, there is still an ongoing converstation about how no one in the field has been able to make a really good, life-like silicone cover for a bionic hand.
But why would you want to?
At first, I thought to myself that the marriage of the two ends of the spectrum would be the ideal outcome - a hand with high functionality and a realistic silicone cover. At face value, it makes perfect sense to try to regain functionality, but to disguise it, so as not to draw attention to the fact that the anatomy is missing. But in this ever-progressing era in which we live (take that with a grain of salt), with tattoos, piercings and body modifications, combined with the broad diversity of fashion choices that we encounter on a daily basis, having something different isn't necessarily a negative thing. Having or wearing something different or unique has become increasingly common, while becoming less taboo.
So instead of trying to look like the T-1000, why not try to look like Iron Man? Instead of covering your prosthetic arm to make it look more realistic, why not show it off? Every person I have met who has a myoelectric hand has been very satisfied with the look, perhaps even wanting to take it one step further to make it look even more out of the ordinary. Wear a copper-plated steampunk arm with moving gears and a rocket fist. WE CAN BUILD IT. The only limitation is your imagination. It can act as a symbol, a way for an amputee to take back what they have lost, to own it and to flaunt it. I mean, c'mon...it's pretty cool, right? A robotic hand? If nothing else, it's a sign of progress that shows what we are capable of as a technologically innovative society. Necessity is the mother of invention, and as long as there are problems to solve, there will be someone out there to find an inventive solution.
Lastly, I have been compiling a list of medical art, illustration, and prosthetics -related websites, blogs, people, companies, and organizations that may be of interest to those who want to find out more about the field. I created a Medical Art Resources page HERE on this blog, and I will continue to add more resources as come across them.