An Acheirian

Child development is considered to be a process that starts within the uterus and involves physical growth, neurological maturation and construction of children's cognitive, social, behavioral and affective skills, thereby making them capable of responding to their needs and the needs of their environment. The first years of life are considered to be critical for child development, given that there is greater cerebral plasticity, which favors development of all of children's potential. Neuronal plasticity is reinforced in the developing brain, and appropriate experience during this period is fundamental for achieving adequate functioning of the neural systems. Because of this plasticity, adaptation to upper-limb deformity will take place, and the child's hand surgeon or therapist should advise the parents about this. The question then will be why treatment should be administered. The response also lies within the concept of cerebral plasticity: what motor capacity potential might the child attain in adulthood if the deformity is corrected, compared with non-treatment of the deformity? Obviously, the response will differ according to the situation. The present author takes the view that, if the correction of the deformities is taken together with the development of the body layout and movement coordination, the functional results in adulthood will be better than if no correction is provided, or it is done late. However, some authors have taken the view that this hypothesis does not have any scientific basis and have advocated a surgical approach applied later on, since the anatomical structures will be larger, which facilitates the surgical approach.

The emotional factors relating to congenital malformations of the upper limbs also have to be taken into consideration. Parents generally carry a feeling of blame and responsibility for their children's deformities. Such conditions often lead to marital and financial problems for the parents, and their appearance needs to be considered to be an event that permanently alters family life.