User-relevant factors determining prosthesis choice in persons with major unilateral upper limb defects: A meta-synthesis of qualitative literature and focus group results.

OBJECTIVE: Considering the high rejection rates of upper limb prostheses, it is important to determine which prosthesis fits best the needs of each user. The introduction of the multi-grip prostheses hands (MHP), which have functional advantages but are also more expensive, has made prosthesis selection even harder. Therefore, we aimed to identify user opinions on factors determining prosthesis choice of persons with major unilateral upper limb defects in order to facilitate a more optimal fit between user and prosthesis. METHODS: A qualitative meta-synthesis using a 'best-fit framework' approach was performed by searching five databases (PROSPERO registration number: CRD42019126973). Studies were considered eligible if they contained qualitative content about adults with major unilateral upper limb defects experienced in using commercially available upper limb prostheses and focused on upper limb prosthesis users' opinions. Results of the meta-synthesis were validated with end-users (n = 11) in a focus group. RESULTS: Out of 6247 articles, 19 studies were included. An overview of six main themes ('physical', 'activities and participation', 'mental', 'social', 'rehabilitation, cost and prosthetist services' and 'prosthesis related factors') containing 86 subthemes that could affect prosthesis choice was created. Of these subthemes, 19 were added by the focus group. Important subthemes were 'work/school', 'functionality' and 'reactions from public'. Opinions of MHP-users were scarce. MHPs were experienced as more dexterous and life-like but also as less robust and difficult to control. CONCLUSION: The huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly. The created overview can be of great value to identify preferences and facilitate user-involvement in the selection process. Ultimately, this may contribute to a more successful match between user and prosthesis, resulting in a decrease of abandonment and increase of cost-effectiveness.

On Replacement Body Parts.

Technological advances are making devices that functionally replace body parts-artificial organs and limbs-more widely used, and more capable of providing patients with lives that are close to "normal." Some of the ethical issues this is likely to raise relate to how such prostheses are conceptualized. Prostheses are ambiguous between being inanimate objects and sharing in the status of human bodies-which already have an ambiguous status, as both objects and subjects. At the same time, the possibility of replacing body parts with artificial objects puts pressure on the normative status typically accorded to human bodies, seemingly confirming that body parts are replaceable objects. The paper argues that bodies' normative status relies on the relation of a body to a person and shows that persons could have similar relations to prostheses. This suggests that in approaching ethical issues surrounding prostheses, it is appropriate to regard them as more like body parts than like objects.

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El artículo muestra la presencia de agenesia de una mano en una niña con síndrome de Down y la atención, cuidados y tratamiento desarrollados durante sus primeros años, dentro de un proceso de integración personal, familiar, escolar y social, hasta llegar a la aplicación de una prótesis mioeléctrica que le permite la manipulación ordinaria en las diversas actividades de la vida diaria

Left hand agenesia in a girl with Down syndrome and its management during the first years of life are described. She showed good adaptation to an esthetic prothesis throughout the first years. Personal, familiar and social engagement was continuously offered. At the age of 5 y, a myoelectric prothesis has been implanted that allows her to practice daily activities more properly. The girl is showing excellent adaptation

Beware of mereologists bearing gifts: prolegomena to a medical metaphysics.

This essay considers implications of formal mereologies and ontologies for medical metaphysics. Edward Fried's extensional mereological account of the human body is taken as representative of a prominent strand in analytic metaphysics that has close affinities with medical positivism. I show why such accounts fail. First, I consider how Fried attempts to make sense of the medical case of Barney Clark, the first recipient of an artificial heart, and show that his analytic metaphysical categories do not have the right kind of fit with the case. A proper medical metaphysic should involve a richer two way dialogue with medicine, and it should not just "apply" formal accounts worked out in other settings. Second, I argue that any effort to account for real wholes with extensional mereological sums requires all sorts of ad hoc, supplementary mechanisms that do the real work, and the full repertoire of these mechanisms involves inconsistencies and semantic shifts. Finally, I consider an alternative strand of work on non-extensional whole/part relations that is closer to medicine and that can deepen reflection on some core problems in bioethics, for example, associated with the determination of death when an organism ceases to function as a whole. In addition to the utility such formal ontologies have for addressing traditional problems such as the determination of death, philosophers of medicine should appreciate the increasingly influential role such formal tools are playing in the development of data system ontologies. Assumptions integral to these ontologies have far reaching implications for the way future research and practice in medicine will be conducted, and much greater critical reflection is needed on the full range of issues associated with the development and use of such medical ontologies.

The fair use of lower-limb running prostheses: A Delphi study.

The purpose of this paper is to investigate the role of lower-limb running prostheses and stakeholders' perceptions of fairness in relation to their use in competitive disability sport. A Delphi study was conducted over three rounds to solicit expert opinion in a developing area of knowledge. High levels of consensus were obtained. The findings suggest that the prosthesis is defined as a piece of sporting equipment to restore athletes' function to enable them to take part in disability sport. In addition, the panel determined that the development of this technology should be considered to be integral to the sport's ethos. Crucially, prostheses technology should be monitored and have limits placed upon it to ensure fairness for both participants and stakeholders.

Enhancing disabilities: transhumanism under the veil of inclusion?

Technological developments for disabled athletes may facilitate their competition in standard elite sports. They raise intriguing philosophical questions that challenge dominant notions of body and normality. The case of 'bladerunner' Oscar Pistorius in particular is used to illustrate and defend 'transhumanist' ideologies that promote the use of technology to extend human capabilities. Some argue that new technologies will undermine the sharp contrast between the athlete as a cultural hero and icon and the disabled person that needs extra attention or care; the one exemplary of the peak of normality, human functioning at its best, the other representing a way of coping with the opposite. Do current ways of classification do justice to the performances of disabled athletes? The case of Oscar Pistorius will be used to further illustrate the complexities of these questions, in particular when related to notions of normality and extraordinary performances. Pistorius' desire to become part of 'normal' elite sport may be interpreted as an expression of a right to 'inclusion' or 'integration', but at the same time it reproduces new inequalities and asymmetries between performances of able and dis-abled athletes: we propose that if one accepts that Pistorius should compete in the 'regular' Olympic Games, this would paradoxically underline the differences between able and disabled and it would reproduce the current order and hierarchy between able and disabled bodies.