IEEE Technology and Society Magazine - June 2015 - 77

specifications, can be questioned. Beyond quantitative
facts and beyond the group within which the person is
categorized, it is the whole person that needs to be considered in order to foresee and understand the appropriation, or not, of a prosthesis.

Use, Conception, and Acceptance
The questions put forward above, regarding certain simplifications of the representation of the "target" in the
process of the conception of prosthetics, highlights the
fact that there are several problems with the definition
and conception of this technical object.
First is the fact that the approach to conception is ill
adapted, tending to consider the object and its technology rather than the related technique or use. This is
particularly problematic in the case of prosthetics, technical objects which require the introduction and learning of new body techniques.
This lack of consideration of use as described in a large
number of studies on the conception of technical objects
[31], tends to cause another phenomenon: the belittling
of the expertise of the user, and more particularly, the
disabled user. The arduousness of the decomposition of
a gesture into a sequence of movements (often necessary
in the case of myoelectric prostheses with several active
joints), the complexity of controlling one (or several) joints
through the contraction of completely different muscle
groups, the necessity of constant visual control to compensate for sensory and proprioceptive loss, and lastly, the
cognitive load generated by the high level of concentration
required to generate contraction signals understandable to
the prosthesis, make the user an expert in the use of his
own body, in the same way that a surgeon is considered to
be an expert with his hands.
The lack of consideration of these issues in the
conception process, leads to compensation by calling
upon humanities and social sciences at the last minute.
The concept of acceptance to which the designers of
technical objects refer, is thus more often than not an
a posteriori sterile justification rather than a prior-toconception real consideration of the needs and uses of
the user and related anthropo-socio-cultural issues [32].
Lastly, the complexity of the questions raised, once
again, highlights the importance of considering the
results of anthropological studies in the conception and
design of prosthetics, as much as results from quantitative/statistical sociological approaches which can
appear more easily exploitable in engineering processes
because of their "mathematical" content.

Integrity and Integration
Beyond anthropological and social issues, a number of
phenomena related to psychology and the neurosciences
influence the appropriation of prosthetics. Two important
june 2015

∕

questions can be posed when proposing prosthesis for an
amputee: that of the physical integrity of the amputated
body, and that of the physical integration of the technology.
The amputated and thus (we could say de facto)
diminished body questions the notion of physical integrity: the damage made to the sacred envelope thatis the
human body alters the representation that the subject
has of himself and can harm his self-perception. This
notion of physical integrity is, nevertheless, still far from
being completely understood: although the injury to the
"body-schema" has been clearly identified in traumatic
amputees (who evoke a "diminished body"), it would
appear that some patients with amelia (born without
one or more limbs) feel quite complete.
The relationship between the assault on the skin and
that on the psyche, a classical subject in psychology,
should obviously be considered in order to understand
the effect which the prosthesis could have on its wearer.
The body envelope holds a high psychological importance, and the simple act of inserting a needle in the skin
has consequences far beyond the physical aspects. It is
thus easy to imagine that the intimacy of prosthetic fitting
and electrode implantation (in the case of a myoelectric
prosthesis) can have a direct psychological effect on the
patient. Above and beyond the fear of pain, complex
symbolisms relating to the "invasiveness" of a prosthetic
device which crosses (recent prototypes use cortically
implanted electrode grids) or comes very close (myoelectric prostheses use surface electrodes) to the symbolic
barrier of the skin can directly affect the user's psyche.
The phenomenon of the physical integration of technology thus has psychological aspects, but in order to
fully understand these aspects, one must also look to the
neurosciences and social sciences. Indeed, when different research communities are questioned on the conditions required for the integration of prosthesis in the body
image, opinions differ, and even the possibility of complete integration is questioned. For neuroscientists, the
relationship between sensory-motor loops and physical
integration appear obvious. Several studies have demonstrated this: research on the subject of the physical integration of vibrotactile devices used to substitute visual
loss [33]; work on the development of the sense of orientation through long-term wearing of a "compass-belt"
which provides constant vibrotactile information on the
direction of North [34], or the "rubber hand" experiments
in which the combination of sensory signals (visual and
tactile) generate the sensation that a rubber hand is a
part of the subject's own body [35].
Of course, the creation of these new sensory-motor
loops requires a learning process which could also be
one of the keys to the physical integration of a technical
object [36]: in the same way that a sculptor will over the
years of use, displace the boundary of his body beyond

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