Making a Statement: Customization Trends in Upper-limb Prosthetics

We live in a visual society where appearances matter, and the evidence of this is all around us. People express who they are through how they look—their clothing, hair style, body art, eyewear, and physique. This focus on personal appearance is playing out in creative ways for people who use an upper-limb prosthesis. 

When Mandie Tavares was being fitted for her new prosthesis, she knew right away that she was interested in something not resembling a natural limb. "I really wanted something that stood out and showed my personality," she said. "What I love about my glossy leopard print arm is that it helps me feel confident. It's really cool, and people are excited to ask me about it, and I'm excited to talk about it."

Wearing a highly customized prosthesis can give people a sense of pride and excitement about being a prosthesis user. The patients we treat at Arm Dynamics are enthusiastic about choosing bold colors, graphics, and a wide variety of bling to make their device eye-catching, something they want to show off and talk about. Customization trends in upper-limb prosthetic fabrication are creating another avenue to increase wear time and patient acceptance.

Fit, Function, Emotion

While customizing the outside of a prosthesis is aesthetically pleasing, it's what happens on the inside that is most essential to increasing the acceptance rate of upper-limb prostheses. It begins with comfort, as in a well-fitting socket, and extends outward to functional use of the prosthesis. When the socket feels like a natural part of the body, people are much more likely to wear their prostheses and rely on them to help them navigate daily life. Simply put, a great looking prosthesis that is painful to wear is going to be quickly cast aside. Socket design and comfort are the foundations of prosthetic success.

The point of getting a prosthesis is for patients to reach their functional goals. Beyond activities of daily living, every patient has different motivations for using his or her prosthesis. The involvement of an occupational or physical therapist throughout the prosthetic rehabilitation process is central to the patient's success. Therapists help guide and support our patients with wound healing and conditioning, pain management, prosthetic training, and psychosocial concerns like anxiety, depression, and substance abuse.

"Increasing patient acceptance rates for upper-limb prostheses is connected with holistic clinical care that looks at the impact of upper-limb loss and limb difference on the psychosocial factors of a person's life," says John Miguelez, CP, FAAOP(D), president and senior clinical director of Arm Dynamics. "This includes not only their emotional status, but their family, social, and healthcare support systems, and their socioeconomic situation."

Arms and hands are highly visible and are an integral part of how people interact with one another. The absence of an upper limb, or the presence of a prosthesis, cannot be hidden, and this can have a profound influence on a person's body image and appearance. A comfortable, functional prosthesis that's uniquely customized to the person's personality has the potential to significantly reduce feelings of social anxiety and separateness, while also improving rehabilitation outcomes.

When Derrek Jones lost his ring finger in an accident at work, he was self-conscious about how his hand looked and mostly tried to keep it in his pocket. "You do a lot of things with your hands, like getting your wallet out, and people notice when a finger is missing."

When he was fitted with a partial hand prosthesis, he asked for it to be customized with a gold finish, to go along with his gold teeth and gold jewelry. "I really like to look good when I go out, and this thing is flashy. Wearing my gold
finger has boosted my feelings and my self-esteem."

Occupational therapists who work with people with upper-limb loss have a deep understanding of the psychosocial challenges these patients are faced with. "When someone sustains an upper-limb amputation, life changes dramatically and many of those changes are beyond that person's ability to control," says Kerstin Baun, MPH, OTR/L, national director of therapeutic services at Arm Dynamics.
"Being able to choose what their prosthesis is going to look like can be very empowering and also result in more frequent and longer wear. And as the prosthesis improves the person's function, it may also improve their outlook."

Evolution and Revolution

Across the history of prosthetic fabrication, prosthetists and technicians have tried to make artificial limbs that mimic the appearance of natural limbs. Many people with limb loss wanted prostheses with aesthetics that matched their natural skin tones, and this was often a more important consideration than function. But as advanced myoelectric components began to emerge, so did a trend toward losing the cosmetic coverings
and boldly celebrating the high-tech, bionic look of prosthetic devices. More recently, a revolution in materials, techniques, and ideas has made it possible to innovate prosthetic arms, hands, and fingers with an entirely fresh and customized appearance.

One such material is silicone, which can be used to improve comfort and aesthetics. Custom silicone interfaces are the preferred choice for most patients because silicone is a natural element that mimics the properties of actual skin. Silicone is biocompatible and has healing properties that promote the growth of new skin. It feels soft and supple as it moves against the natural skin of a residual limb, and patients report that silicone interfaces feel cooler and increase the feeling of secure suspension of the prosthesis.

People can choose the colors they like—everything from pastels to fluorescents to black and white. There are also options to incorporate glitter or glow-in-the-dark powder. Being able to choose the color engages patients in the fabrication process and adds a little fun factor. Children are especially excited to talk about colors and how they want their hands to be special.

To achieve a completely customized fit, the patient's residual limb is plaster casted by a prosthetist, who then works closely with a silicone technician to map out sensitive areas like neuromas, scars, and bony prominences, where extra durometers of silicone will be layered for cushioning. Silicone fabrication requires an investment in equipment and materials, but the most important factors are the skills and silicone experience of a dedicated technician.

Customization and Fabrication: Vinyl Wraps, Gel Coating, and More

Of the innumerable techniques available for customizing a prosthetic device, the most common approach is to customize the frame of a prosthesis. Vinyl wrapping is a popular choice due to the wide array of colored and patterned vinyl wraps that are available online. We work with the patient to look at the options and select a wrap that matches up with their ideas. We typically use custom automotive wraps because they are high-quality, durable, and provide superior stretch and recovery when heated.

The process of vinyl wrapping begins with a thoroughly clean and dry frame. We cut a piece of vinyl to cover the frame and initially place it on the frame where it will be seamed. A strip of cutting tape is laid down near the edge of the vinyl, and when the vinyl is fully wrapped around the frame, it covers the tape, which will then be pulled through to create a nice, clean seam.

The vinyl is heated and stretched over the edges by hand, and air bubbles are squeegeed out using a felt-lined hand tool. The edges are trimmed with a fresh razor blade, preferably on the inside edges of the frame. The seam and all edges are carefully sealed with a bead of liquid glue to keep them from pulling up. Before attempting to do a vinyl wrap, check out some of the vinyl wrap tutorials on YouTube and watch several to establish a base of knowledge.

Gel coating is another customization technique that delivers an impressive visual win. It can be used as the final glossy coat on a carbon fiber socket and sometimes over vinyl wraps. More frequently, gelcoat is applied when patients want to feature vinyl lettering, photographs, or artwork on their frame.

Gelcoat is a liquid that hardens to form a thick outer layer to protect the underlying surface from being damaged by moisture and scratches. It is sometimes referred to as marine gelcoat since it is used as a shiny but tough final layer on fiberglass boats.

Gelcoat may be applied with a roller, paint brush or spray gun. One way to evenly apply gelcoat to a cylindrical object like a prosthetic frame is to use an adjustable-rate rotisserie. This controls the flow of gel coating resin around the frame. After the gel coating has rested and self-leveled, the surface is reheated with a handheld propane torch to release any air bubbles and leave a smooth, shiny finish.

Gel coating tips:

• Make holes in the frame after the gelcoat is completed to avoid separating the gelcoat from the frame
• Tape up the edges from the inside of the frame and seal it up to the edges with epoxy glue
• Create volume by using plenty of resin across the surface since it thins out when heatedCheck out gel coating tutorials on YouTube

Most of our favorite ideas for customizations have come directly from patients. The excitement is contagious as we begin collaborating with them to create the prostheses that they envision. Twelve-year-old Lina not only knew exactly what she wanted her arm to look like, she even created a slide show to explain the concept to her prosthetist.

"Teal is my favorite color and I wanted it to have golden swirls too. ‘Live, laugh, and love' are also part of the message, and that's a reflection of who I am. It shows that I embrace being unique. My prosthesis is a tool that I can use to do lots of things, and it just helps my confidence."

There are a range of unique customization requests that we've created for our patients. Examples include built-in accessories on the frame—a bottle opener, a compass, a Swiss Army knife, and even an Apple watch. Some partial hand patients have asked for zippers to be added to their colorful, custom silicone interfaces, making it easier to don and doff the device, while being a new and interesting accessory at the same time. We have also integrated LED and fiber-optic lights into our designs to create some totally unique and artistic lighting effects.

Other patients are interested in dramatic or theatrical interpretations of prostheses that would fit in with cosplay and events like Comic-Con.

Henry Cox has a partial hand amputation and is a fan of the character Thanos from the Avengers: Infinity War and Endgame films. He wanted his new hand to replicate the gauntlet worn by Thanos. We sourced some "infinity stones" from Amazon and fabricated a golden gauntlet to fulfill Cox's request. Placing LED lights behind the stones created a glow, and when Cox donned the prosthesis,
he was thrilled to be wearing his own infinity gauntlet.

Successful Outcomes

The creative customization of upper-limb prostheses is a world of fresh ideas, concepts, and outside-the-box thinking. The way patients feel about the appearance of their prostheses is extremely important and needs to be respected. Customization reaches beyond conventional thoughts about limb replacement and seeks to enhance individuals' self-image and affirm their new lives after limb loss. Customization makes it possible to reimagine a prosthesis as functional art, and in the process, lift patients to higher levels of optimism and self-assurance.

Baun is directly involved in compiling research data from patients. "Based on our psychosocial screening at the beginning of the prosthetic fitting process, we know that more than 50 percent of upper-limb amputees screen positive for depression, and many struggle with PTSD, pain, quality of life issues, and more. Having a voice in how the prosthesis is going to look may seem like a minor issue, but it can make all the difference in a person's outcome. Assuming the fit is comfortable, and the prosthesis meets their functional goals, customized finishes can be the difference between having to wear a device and wanting to wear a device."

Our collaborations with Mandie, Derrek, Lina, Henry, and many others have corroborated this data and taught us that successful prosthetic outcomes are often intertwined with how patients feel about the appearance of their prostheses.

Witnessing how much it means to our patients to make a statement with their prostheses is a testament to the fact that customization is more than a frill or a luxury—it is a powerful psycho-logical component of their recovery and a critical aspect of their prosthetic journey.

Rob Dodson, CPO, FAAOP, is the clinical manager at Arm Dynamics, Southwest Center of Excellence, Dallas.

Brennan Hooper is a silicone prosthetic technician at Arm Dynamics, Southwest Center of Excellence, Dallas.

Rob Duerksen is a prosthetic technician at Arm Dynamics, Southwest Center of Excellence, Dallas.

Sherri Edge is a writer and video producer who specializes in marketing and communications for the prosthetics industry.