###### Abstract  
This study investigated the impact of early prosthetic intervention on children with upper limb agenesis or amputation. The aim was to assess both how early prosthetics improve a child's movement and coordination skills, as well as how satisfied both the child and their parents are with the prosthesis. Twenty-nine children were evaluated using the Unilateral Below Elbow Test (UBET) and Child Amputee Prosthetics Project--Prothesis Satisfaction Inventory (CAPP-PSI). Results suggest that while children performed tasks faster and more fluidly without a prosthesis, they were satisfied with the prostheses and the service provided. This may be due to ongoing adaptation to the new device. The single child re-evaluated at 12 months showed improvement in prosthesis use, highlighting the potential benefits of early intervention coupled with motor re-education. Further research is needed to optimize prosthetic features and address initial challenges associated with prosthesis use. upper limb agenesis; amputation; children; prosthesis; motor function; quality of life +
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of prostheses goes hand in hand with a set of interventions, including physical therapies, motor re-education, and psychological support, which together contribute to the success of the therapeutic approach. Therefore, it is essential to consider prosthesization as part of a broader system of care delivered by a rehabilitation team that works together to achieve the ultimate goal of rehabilitation and the improvement of the child's autonomy and QoL [3]. Amputations, or congenital malformations of the hand and upper limb, represent an eventuality that is not particularly frequent in clinical practice, and the literature is relatively poor in epidemiological studies on the subject [4; 5]. Agenesis of the upper limb involves the congenital partial or total absence of either upper limb and can occur in various forms, ranging from complete absence of the limb to absence of parts of it. Most limb malformation abnormalities occur during the embryonic stage of differentiation. The malformation is understood as an abnormality during formation and/or differentiation, may be associated with a specific part of the developing limb, and may result in an abnormality affecting the entire limb or only part of it [6; 7; 8]. Not to be overlooked is the fact that these pathologies of the upper limb are not infrequently associated with other independent malformations or resulting from genetic syndromes such as Holt-Oram, radial aplasia with thrombocytopenia, De Lange, and others [9; 10; 11; 12; 13; 14]. These defects may go unrecognized or unrecorded. In addition, minor abnormalities may never be detected or recorded. The incidence of agenesis of the upper limb, therefore, varies depending on the populations and study methodologies adopted, as well as the geographical area studied, but is generally estimated to affect 1-2 per 4000 live births [1; 15]. With regard to upper limb amputation in children, on the other hand, the causes are mainly trauma, tumors (such as Ewing sarcoma and osteosarcoma), infections, or congenital malformations [16; 17; 18; 19; 20; 21]. Children with agenesis or amputation of the upper limb are confronted with four main challenges: (1) difficulties in the development of normal motor skills, (2) the need for assistance in daily activities, (3) limitations in certain activities of daily living (ADLs) and in sport, and (4) potential emotional and social problems due to physical appearance [22]. The Neuronal Group Selection Theory (NGST) comes into play to support the thesis that early prosthesization can be beneficial for the child.