Aesthetic devices respond to emotional needs and can lead to “positive conversations”
By Nicole Wetsman
In the early 1900s in the United Kingdom, the National Health Service considered glasses and spectacles medical devices—designed to be functional, but without any consideration of style and experience.1 As a result, said Stefania Sansoni, PhD, companies that made eyeglasses didn’t think about their appearance. “They were thinking about not attracting attention,” she said. “This is not something that is a work of design, this is something that should compensate for a problem.”
As decades passed, glasses became a personal fashion accessory, and hundreds of companies now employ countless designers with style explicitly in mind. For Sansoni, who studies visual design in prosthetic limbs, the parallel to her own research is clear: “Until a few years ago, the idea was that a prosthesis is just a technical product that has to help a person hide the amputation,” she said. Today, there’s more consideration paid to the user experience, and attention to form as well as function.
Data show that this change of focus has implications for the mental and emotional health of amputees: The appearance of a prosthetic or prosthetic cover affects amputees’ mental health and their relationships with their artificial limb.2-6 Though options are still limited, start-up companies are beginning to fill the market with covers to fit the individual tastes and needs of amputees.
“The common concept is that anything functional has to be the best option for patients,” Sansoni said. “But there is a strong connection between the visual aspect of the prosthesis and the acceptance of the prosthesis by patients.”
The Importance of Design
Amputees who are satisfied with their prosthetic limbs report better quality life and lower amounts of self-disgust associated with their amputation. In one 2015 study2 of 51 male traumatic limb amputees at a military rehabilitation center, those who scored higher on a measure of prosthesis satisfaction had lower scores on tests of psychiatric symptoms, such as anxiety and depression. A recent study, published in September 20183 in the journal Body Image, found that satisfaction reduced self-disgust in 83 lower limb amputees.
In 2014, a research team surveyed4 153 lower-limb amputees in the United Kingdom seeking to identify the reasons for satisfaction or dissatisfaction with prosthetic limb covers: Appearance was the primary complaint of the majority of respondents.
“We thought people would be unhappy with the length of time their covers lasted, or perhaps the fit,” said Jonathan Corney, a professor in the Department of Design, Manufacture and Engineering Management at the University of Strathclyde in Glasgow, Scotland, who conducted the study on reasons for satisfaction. “But actually, most if not all of them were unhappy with the appearance. It was a clear message.”
Apart from this study, academic research into the cosmetic elements of prosthetics and prosthetic covers is fairly limited, Corney said. However, the studies that have been done are bolstered by anecdotal reports that also suggest that appearance is a key factor. “I’m told by colleagues who are prosthetic professionals fitting limbs that it’s very significant,” he said. “It changes people’s morale. The experts, the people in contact with prosthetics users, take it for granted.”
A stylized or attractive prosthesis also may make people more comfortable displaying their limb. “After an amputation, people might be embarrassed or ashamed to leave the house. The option of a prosthetic that is responding to their needs, maybe that’s colorful, that makes them feel confident, can help them engage in social activities,” Sansoni said.
Emery Vanderburgh, a lower-limb amputee who works at Alleles Design Studio, a Canadian company that makes custom prosthesis covers, agrees. “I’ve found it’s a really good ice breaker,” said Vanderburgh, who wears her company’s covers. “It starts a positive conversation, and it’s something people can be proud of. It changes to something that’s really optimistic and positive and contributes to an overall sense of wellbeing.”
Vanderburgh said that people who use the Alleles covers send messages and emails to that effect, as well. “They showcase the leg, and it improves how they function in real life. They’re not trying to hide that they’re an amputee,” she said.
The specific type of design or cover that would be most helpful varies from person to person, depending on their age, lifestyle, or distance for amputation, Sansoni said.
Coming to terms with the use of a prosthetic limb is an adjustment process, and individuals need different things from their covers and from their prosthetic designs at different stages of that process, for example. Amputees likely go through a quasi-grieving process, broken into unique stages—and the appearance of the prosthetic one wants early in the process is likely different than the one they might want later on. In the initial stages (when patients may not have accepted the loss of the limb), they benefit from and desire realistic looking limbs, Sansoni argues in her research.5
“But in the long term, a prosthetic device that doesn’t look like the lost limb, that looks like a robotic device, might benefit psychologically,” she said.
In a 2015 study6 on prosthesis aesthetics, Sansoni found that men tended to prefer more robotic prosthetic limbs, whereas women preferred realistic-looking limbs—however, the study noted that the finding was an early generalization. The research also compared the reactions of people from Britain and Italy to various prosthetic limbs and noted that British people were slightly more attracted to robotic devices. The results, the authors noted, indicate that there is likely a cultural component to prosthesis preferences.
Corney said that he too has observed generational differences in the types of prostheses that amputees like to wear. Older individuals, who might normally wear pants or longer skirts, tended to be less concerned with the appearance of their covers, because they were hidden by clothing. “Younger prosthetics users were happy to have their tech on display,” he said.
Alleles’ clients, Vanderburgh said, tend to have a sense of style and personality, and take advantage of the range of options they have available. “We have people who want bright flashy colors, that stand out. Or, people often choose more subtle designs that give a sense of shape without becoming the main focal point of what they’re wearing.”
Filling A Hole in the Market
Amputees have more options available today than they did a decade ago—and tend to be aware that there are choices available—but the industry is still lagging behind, Vanderburgh said. “Within the prosthetic industry, there’s still this utilitarian perspective,” she said. “It’s so important to consider the function when you’re building the prosthetic, and it’s taken a lot for that technology to grow. Now, we’re starting to open up that option for style.”
As options expand, their cost range should as well, researchers said. Right now, Corney said, most prosthetic cover options are either at the very low or very high end, in terms of cost. “At the bottom end, you have bits of foam sculpted by a technician into a leg-like shape. They’re covered with essentially a couple of ladies’ stockings for skin. At the other end, you have expensive covers that are hand painted,” he said.
Alleles’ covers, for example, start around $350 UNYQ, another design company, has prosthetic covers starting around $500.
“There doesn’t seem to be much in between, at least nothing established,” Corney said. “There’s a real area for innovation.”
With innovations in 3-D printing and other technologies, it’s feasible that costs for these products might come down, Sansoni said. She noted that she’d like to see those strategies, and visual design techniques, incorporated into the manufacturing process for prosthetic limbs at the outset.
“My hope for the future would be for prosthetic centers to engage in design for prosthetic users, and chose designs that make people feel good,” Sansoni said.
Nicole Wetsman is a freelance writer who lives in New York City and writes regularly for LER.
- Gooding J. Rather unspectacular: design choices in National Health Service glasses. Sound and Vision. Spring 2017: DOI: http://dx.doi.org/10.15180/170703.
- Durmus D, Safaz I, Adıgüzel E, et al. The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees. Compr Psychiatry. 2015;59:45-53.
- Burden N, Simpson J, Murray C, Overton PG, Powell PA. Prosthesis use is associated with reduced physical self-disgust in limb amputees. Body Image. 2018;27:109-117.
- Cairns N, Murray K, Corney J, McFayden A. Satisfaction with cosmesis and priorities for cosmesis design reported by lower limb amputees in the United Kingdom: instrument development and results. Prosthet Orthot Int. 2014;38(6):467-7.
- Sansoni S, Buis A, Wodehouse A. Psychological distress and well-being in prosthetic users: the role of realism in below-knee prostheses. Presented at 9th International Conference on Design and Emotion. 2014; Bogata, Colombia.
- Sansoni S, Wodehouse A, McFadyen A, Buis A.. The aesthetic appeal of prosthetic limbs and the uncanny valley: The role of personal characteristics in attraction. Int J Design. 2015;9(1):67-81.