This week’s guest column comes from Ali Hussaini, a research fellow at the University of Portsmouth specializing in the provision of affordable upper-limb prostheses. Hussaini’s work explores emerging medical interventions, functional assessment tools, barriers to new technologies, and healthcare outcome measures for improved quality of life.

Just for fun, go to YouTube and do a search on your favorite prosthetic hand. The results will yield an abundance of videos that feature quick-scene transitions, inspirational music, water bottles having the life squeezed out of them, and expensive research projects masquerading as customer-ready options.

Technically, what you’re being shown—the range of motion, the novel orientations—is achievable by a prosthetic device. But there’s a lot that you’re not being shown in many of these product videos. For example, you probably aren’t being shown the transitions between grip patterns. You usually don’t get to see that it’s necessary to use your anatomical hand to manually reposition your prosthetic thumb or push a mode switch button. How do you show a person providing a series of pre-programmed muscle signals to alter the finger configuration? If you see the hand grasping an object, you may not see the grasping motion—the object is already in the hand when the scene begins. Or it’s placed there by the other hand. As a general rule, if you don’t see a residual limb in one of these lovely promotional videos (only the device), assume the device requires some extra effort that’s not being depicted on screen.

If the videos filled in all these gaps, you’d have a more realistic impression of how functional the device actually is. But you also might be less eager to pursue it. For example, you might anticipate the pain in your elbow, shoulder, or back that might result from extensive use. You’d gain a clearer sense of the limb’s limitations and the tradeoffs it involves.

In one of my favorite examples of this genre, a pen (with the cap already removed) is carefully placed into a prosthetic hand and grasped with a tripod grip. Hard cut to the pen writing some words; then another hard cut to a money shot of the pen underlining what’s been written. At no point am I allowed to see a residual limb actually inside the prosthesis. Reality is just out of frame.

It’s not that this video is lying. It’s telling the truth about what the prosthesis is capable of—yet it’s still creating false expectations. Here’s how you, the viewer, can equip yourself to discern the true picture that may be hiding just out of your view.

Truth in Advertising vs. Advertising Reality

If you’re interested in a prosthesis (some people are not, and that’s their choice), you have a lot of different voices talking to you from many different points of view. All parties have good intentions and want to provide a solution that improves your quality of life. But they often have competing interests, leaving you with a jumble of information that creates more confusion than clarity. You can end up feeling suspicious and jaded, less sure than ever of the path forward and questioning whether anything resembling success is around the corner.

The conflicting voices in your ears might include:

* Clinics that are set in their ways, uninformed about emerging technology, and either unable or unwilling to give you straight answers to some of your questions.

* Buzzy startup ventures that put too much effort into their social media blitz and very little time into consulting with prosthetists.

* Manufacturers with glossy promotional videos that are heavily edited to obscure the limitations and personal costs (such as cognitive effort or physical fatigue) of their products.

* And, of course, health insurers who focus their efforts on providing the most economical level of coverage, rather than one that restores any semblance of wholeness to your life.

Fortunately, these aren’t the only resources available to you. Many prosthetists will partner with you to explore outside-the-box solutions, even if it requires a learning curve on both their part and yours. And most practitioners provide truth in advertising, giving honest answers to your questions no matter how inconvenient (to you, or to them) the truth might be. If you don’t have that type of trust in your current prosthetist, it’s time to find a new one.

But your best source of information about the reality of prosthetic interventions are prosthesis users. If you want a complete picture—from cleaning your limb to rolling on a liner, donning a socket, connecting a terminal device, and putting the prosthesis to use—nothing beats a current user. You can find their videos on YouTube and elsewhere, and they are the gold standard. Some of these videos might be long and dull, but most will at least provide you with the kind of accuracy that’s often lacking in promos from manufacturers, 3D-printing ventures, and research groups. When a person removes their prosthetic leg after a 10-minute walk to show you the pressure points, blisters, and swelling, and then “pours out” their socket, you know you’re getting the unvarnished truth.

In addition, users often address non-prosthesis-related issues that never come up in the promotional videos. Things like:

* It scares my kid.
* I can’t make the payments on the car now.
* My spouse does this for me. I don’t care how long you train me to do this.
* People I don’t know ask me personal questions. My prosthesis is not an invitation to touch my legs.
* I can’t tell you how it broke. I’m scared worker’s comp will reduce the amount I receive every month.

One caveat. If you’re watching a video made by a prosthesis user, make sure you note the date the video was published. There may be more recent videos where the person has changed their mind about certain things, acquired more information about their device, and gained new perspectives on old opinions. Integrating the prosthesis into your life is a continuous process. You should expect your needs to mature as you grow as a person. This is normal.

And remember, you’re going to find people who give you the straight dope, and you will find people who are boring as sin. The internet provides a medium. It does not train people to be good presenters. Don’t be too discouraged if a given video isn’t helpful. Just move on to the next one.

For any prosthetics manufacturers who might be reading, I’ve got some ideas for you. I think you can make a large impact on truth in advertising, because your content is often viewed first. Here’s what I’d like to see:

1. Show less technical aptitude of the prosthesis (specifically the advanced tech) in promotional videos. Show more advancement of the body biomechanics. No suggestion of a user. If the device usage implies a person is present, that person (or at least the limb) needs to be in frame.

2. The selection of grasped objects needs to move away from light, dumb materials, or any compliant object that compensates for an upper limb prosthesis by conforming to the fingers and palm. Here are some tips for showcasing function:

* Clothespin grasping is great because there is an “object-interaction.” The torsion spring in the clothespin is fighting with you, and you need to maintain a grip. Poor grip means the clothespin will fall from the prosthetic hand’s grasp.

* Bottled water grasping should be done with the cap unscrewed, so a user can see whether the hand will stop squeezing in time. No water should overflow when a full bottle is grasped.

* If you’re really confident, Dixie cup.

3. Advance prosthetic feet/knee/legs? Wide shot of a person walking across changing terrains carpet/tile/grass. We need to see the fully body biomechanics when adapting speeds to maintain balance.

4. 3D printed hands? No more short sleeves. Let’s see the hand go through the elastic cuff of a winter jacket.

That’s just a starter list. The bottom line: Show less device functionality, more functional user.