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Vine Arm prosthetic limb

When prosthetics meet aesthetics

Image credit: Omkaar Kotedia

Prosthetics by definition need to be functional, but can they be stylish as well? It seems the only limitation is imagination.

I was holding a disembodied foot – and my feelings about it were mixed.

It was the end of a day shadowing in a prosthetics clinic. I’d sat in, quietly, on a consultation, then a fitting, then followed the prosthetist through to the workshop, where a pane of very strong, very hot acrylic was stretched by three technicians over a plaster cast of the patient’s upper leg.

I watched the small holes sawn into the plastic, into which were slotted the lengths of metal tubing that were cut to size and then fitted onto an incredibly technical (and incredibly expensive) knee joint.

This, in turn, connected to a prosthetic lower leg, then to an ankle joint, then to a foot. The finished silhouette was – barring the skeletal pivots at the knee and ankle – perfectly human.

Then the prosthetist offered me the foot to inspect up close. The ‘skin’ was specially colour-matched silicone, subtly mottled and shaded. The toenails were translucent pink. And the faux joints in the toes sprouted tiny, light brown hairs. Except for its uncanny rigidity and chrome ankle socket, this would easily pass for a human foot. A foot that could be hidden in a shoe, attached to a leg that would vanish under a dress or a pair of jeans.

This is what that painstakingly crafted foot was designed to do: to blend, to fade, to disappear seamlessly into a person’s life; to catch no eyes and draw no gazes.

Holding that foot, marvelling at this uncanny simulacrum, I found myself asking why that should be.

Stigma has always existed around people with limb loss and those who compensate for that loss with prosthetic limbs. Since the end of the First World War, when simple, prostheses not much better than mannequin limbs were mass-produced to funnel wounded veterans back into physical labour, prosthetic limbs have aspired to be functional and invisible. Over the past few years, however, smaller prosthetics companies have begun to reject that mindset.

When Open Bionics began testing its prototype 3D-printed lower-arm prostheses, children with limb loss were a key demographic. Prosthetic limbs for children are notoriously difficult to produce and maintain. To be in proportion, the limb has to be smaller than an adult prosthesis – creating an engineering challenge of how to then fit the same functionality into a smaller space. At the same time, children’s limbs also have to be lighter, so as not to become uncomfortable or painful to wear for long periods. Finally, children grow. Which means a socket that fits perfectly one year could be painful or unusable by the next.

This can lead to a depressingly predictable cycle: child gets clunky, possibly ill-fitting limb; other children notice; child gets bullied; repeat. And so that child does what children do: they try to hide the thing that marks them out as different, which in turn makes the prosthesis less effective. Their relationships – both with other children and with their own limb difference – begin to spiral.

Unchecked, those early experiences carry over from a painful childhood into a bruised and wary adulthood, where the limbs now available can be tucked away under sleeves and trouser legs or shoes and silicone. Camouflage becomes a survival strategy, and the market follows the demand.

“If you’re born without a hand, pretty much every experience that I’ve heard from adults is that bullying at school was really bad,” says Samantha Payne, co-founder and COO of Bristol-based Open Bionics. “Growing up without a prosthesis, or with a prosthesis that doesn’t make you feel good, is an awful experience. You’re made to feel as a child that your amputation is a weakness. There’s a lot of stigma around showing your amputation, so a lot of children learn to hide their limb behind their backs, even in photographs.

“When you talk to these users for the first time about their experiences, it’s really traumatic for them. There are often tears; it’s so sensitive. Those adults, when there hasn’t been [a suitable prosthetic] available, usually don’t use anything because they don’t want to use a hook or a [low-quality] prosthetic hand. So they teach themselves to ‘adapt’.”

Open Bionics’ unique solution is its Hero Arm: a series of highly stylised lower-arm prostheses that take design cues from Hollywood and video game sci-fi. In 2008’s ‘Iron Man’, when billionaire genius inventor Tony Stark is building the first iteration of the superhero’s trademark power armour, the suit screws and bolts itself together into bland-if-functional chrome golem.

The next design, for purposes of “fuselage integrity”, is milled an alloy of gold and titanium. The blindingly gaudy result, Stark remarks, is “a little ostentatious”, and so he directs Jarvis (an artificially intelligent digital manservant) to “throw a little Hot-Rod Red in there.” “Yes,” the computer answers dryly. “That should help you keep a low profile.”

It doesn’t. But while a flying battle-suit might perform its function better in something outwardly more drab, Stark’s ostentatiousness translates perfectly into one of the designs for the Hero Arm. Thanks to a partnership with Disney, children with lower-arm loss don’t have to hide their limb loss with something drab and functional. They can choose a ‘Star Wars’ arm, printed in the orange-on-white colour scheme of the roly-poly BB-8 droid; a glacier-blue ‘Frozen’ arm flecked with snowflakes; or the ‘Iron Man’ arm, reproduced faithfully in contrasting red and gold.

The lightweight plastics used in the covers, frame and socket keep the arm light and also enable regular refitting as child users grow. These arms aren’t meant to be hidden or tucked away. They’re meant to reverse the dynamic of the playground. They aren’t disguises; they aren’t even armour. They’re statements: brave, aspirational and cool.

They’re also highly functional. The Hero Arm comprises a posable wrist joint and independently flexing digits, controlled by a combination of single grip-selector button and myoelectric sensors that translate electrical signals from the wearer’s upper-arm muscles into grips and gestures: letting users grip and lift an object weighing up to 8kg, put it down again and then offer a thumbs up. Its users – whether children flaunting Disney or adults with simpler covers – love it. Some even go on to become brand ambassadors or ‘Bionic Heroes’, including Tilly Lockey, whose first Hero Arm was fitted when she was 10 years old.

“[She] is like my role model,” says Payne of Tilly, who currently poses on the company’s website in a pair of Hero Arms styled after the titular cyborg character in James Cameron’s ‘Alita: Battle Angel’. “Her confidence is incredible.”

Tilly was one of the company’s first Bionic Heroes and its first literal poster child for the Hero Arm. At 15 months old, she lost both arms below the elbow to meningococcal septicemia. The prosthetic replacements available to her through the NHS were, in her words, “very basic”: grippers comprising four fingers and a thumb that opened and closed in a claw-like motion. Her mother contacted Open Bionics through the company’s Facebook page while the arm was still in development.

Tilly Lockey, Alita Hero Arms

Thirteen-year-old Tilly Lockey recently received an ‘Alita: Battle Angel’ Hero Arm

Image credit: Open Bionics

Tilly was invited to help test the prototype limb and to give feedback. That feedback, says Payne, was so comprehensive that the company even added a new function: a ‘freeze’ mode for the arm that locks the five digits in place, letting users hold delicate objects without fear of an involuntary twitch or twinge in the upper-arm being misinterpreted by the arm as a signal to let go.

Tilly’s story is available in her own words on the Open Bionics website, and has been retold in countless TV, print and online interviews. But the mental health benefits of beautiful prostheses extend across the spectrum of amputees: whether they’re adults or children, whether their limb loss is congenital or the result of disease or an accident in later life.

“It depends on the person,” Payne says of how amputees of different ages and backgrounds feel about the Hero Arm. “Kim, one of our ‘Power Users’, is a grandparent and she was super-ecstatic when she got her Hero Arm. She lost both her hands, so for her this was a massive piece of independence back. [What’s more,] she was really excited that she got to pick the colour of her arm.

"We get the same reaction from eight-year-olds. Dan, who is an ambassador and has been working with us for a long time – he gets as excited as children do when he gets a new cover or an arm upgrade. So the reaction is very similar across the board: whether you’ve lost your hand through a traumatic experience or you’re born without a hand.”

Open Bionics delivers individuality to its users through custom shells for its Hero Arms – but whether the arm is for an adult or a child, the functionality is consistent. The covers can be swapped out – colour-matched for different outfits or installed in the guise of a new superhero – but the technology underneath remains standard, affordable and suitable for everyday use.

For amputees who want a limb that’s more specialised but equally eye-catching, designer Sophie de Oliveira Barata’s Alternative Limb Project can offer something more bespoke.

“I didn’t have any personal connection with anyone who was an amputee,” De Oliveira Barata says of her induction into the world of prosthetics. “Art and medicine had always been kind of running in parallel for me. While I was at art school, I was working at the hospital as well – just a kind of tea and coffee person. I remember them doing these emergency drills to see how everyone would operate in a disaster and they had makeup artists to make it convincing. That’s how I got interested in special effects: I was kind of fascinated with the recreation of the wounds and the blood and gore and stuff... Which is funny, because that’s kind of the opposite of what I’m doing now.”

‘We want ownership over our bodies. I think it’s the same in prosthetics. People don’t want to hide that they have a limb difference anymore.’

Sophie de Oliveira Barata, The Alternative Limb Project

When de Oliveira Barata speaks to me, it’s late on a Friday afternoon and I’m sandwiched between the end of her work week and a social engagement. Nevertheless, she’s insistent that I ask her everything I want to know, and answers questions with a crackling enthusiasm that arcs frequently off on tangents, before she loops back on herself to the original topic. Ideas are launched, presented and dissected in a mile-a-minute conversational style that squares comfortably with her portfolio of prosthetic limbs that includes a coiling Vine Arm, a jet-black Spike Leg and a lower-arm on which the skin appears to peel back and reveal a nest of writhing snakes.

“Sometimes it’s not necessarily even for them,” she explains of the more extreme prostheses she produces alongside her work partner, prosthetist Chris Parsons. “It’ll be like an unspoken conversation for them to have with other people, a way to interact with society around them. They can send out a positive message: ‘I’m OK’.

“For example, there’s a lady who came to me who was born with her arm [missing] from below the elbow. She told me, ‘I’m totally fine and functioning’. A lot of lower arm amputees don’t bother wearing prosthetics, but [she said] she could always tell when someone had clocked that she only had one arm. She said she could feel that there was a different energy in the room. She wanted to be able to ‘freeze’ that moment and say, ‘Look, I’ve just noticed that you’ve just noticed my arm. It’s all right. Everything’s good! It happened at birth.’ She wanted to [send that message] and for them to get over it quickly and move on.”

Not all of de Oliveira Barata’s prostheses are for everyday wear, and their prices reflect that (the cost of an Alternative Limb usually starts at around £1,000, rising as the design becomes more intricate). She compares wearing more elaborate pieces to “putting on a beautiful dress when you’re wanting to make a bit of a statement”. Each limb begins with a consultation, with the client outlining ideas about style, aesthetics and functionality. Once the proposal has been sketched out, de Oliveira Barata works with Parsons to ensure that neither form nor function overly impinges on the other.

“That’s the tricky thing with prosthetics: if you imagine a triangle, you’ve got functionality, you’ve got comfort and then you’ve got aesthetics,” she says. “You’re obviously trying to pursue all of those, but if you push in any particular direction then the other two can suffer.”

De Oliveira Barata worked for nine years at a company making realistic prostheses before founding the Alternative Limb Project, and between her and Parsons they can usually design, build and deliver a project themselves – but as and when specialist expertise is needed, contractors are drafted in on an ad-hoc basis.

“We work from scratch together,” she says. “Chris fits the components and I work on the aesthetic side of things, whether that’s shaping the leg in foam and then putting the skin over the top, or a 3D-printed clip-on cover. The Vine arm we created recently, for example, had electrodes and sensors in [the client’s] shoes, so when she moved her toes, the Vine moved in different directions.”

Not all of the studio’s clients are looking for outlandish pieces, however. Many of the Alternative Limbs modelled in the studio’s portfolio are more subtly eye-catching – still recognisably human, but made from transparent or coloured plastics, metal, lace, leather, beads, feathers, resin and crystals. But De Oliveira Barata does still make some custom, ‘realistic’ prostheses for a smaller number of clients: either those who want the option of swapping between the designer and the day-to-day, or people who decide that their limb loss isn’t ready for public scrutiny yet.

“There are a few people I’ve met early on who have said that they’re not interested in having an alternative limb who then years later really embrace the idea,” she says. “And then there are people just like anyone with a wardrobe of different clothes who want a realistic limb and an alternative-style one.”

Realistic limbs are still the standard in the prosthetics industry. With the exception of a few expensive outliers in a very few specialist fields – the Paralympics provides some good examples – the vast majority of prosthetic limbs don’t offer anything extra than the flesh-and-blood limbs they’re replacing. They began as low-tech make-dos designed to be hidden. More recently, they’ve offered an outward return to normality. But now prosthetics is moving into a different era, where limbs aren’t just medical ‘replacements’ or markers of loss – but personal, powerful statements of pride.

“[Realistic limbs] are very technically impressive,” Open Bionics’ Payne says. “It’s art. Their [creators] are artists. But I think culture has shifted and grown. We used to like conformity, and that’s why cosmetic hands were so important and why they were so popular. But that’s not where we are now. Now, everyone’s dyeing their hair different colours and we want to be individual and have self-expression and personal choice. We want ownership over our bodies. I think it’s the same in prosthetics. People don’t want to hide that they have a limb difference any more.”

“There’s a big interest in prosthetics, now,” de Oliveira Barata agrees. “Prosthetics is exciting – both the kind of work that I do, but also [prostheses at] the Paralympics. It helped with the vision of people with incredible bodies still doing incredible things... I get a lot of people contacting me who have not even had surgery yet, people who are just about to. And they’ve said that they’ve been inspired by my projects, that they feel like there’s some hope.

“So, that’s the area I’m focused on. The more inspirational approach of: ‘What could the body be?’”

 

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