MCP flexion averaged 55 degrees in reconstructed thumbs, compared to 75 degrees in the contralateral thumb. Ablation with collateral ligament reconstruction
Advantages:
The reconstructed joints tend to remain flexible. Also, it preserves the nail bed and physis, this increases the prevention of nail deformities over time. Disadvantages:
Although surgeons try to obtain a stable thumb of appropriate size, instability of the IP and MCP joint may occur, as well as a size mismatch. Thumbs are defined as unacceptable if IP joint deviation exceeds 15 degrees, MCP joint deviation exceeds 30 degrees, and thumb size is inappropriate based on the examiners assessment. Also, thumb size one-third greater or less than the contralateral thumb is defined as unacceptable. On-top plasty procedure
No surgical outcomes studies exist for evaluating the function of the thumbs after an on-top plasty reconstruction. Central polydactyly
Few clinical outcome studies exist regarding the treatment of central polydactyly. Tada and colleagues note that satisfactory surgical correction of central polydactyly is difficult to achieve and that outcomes are generally poor. In Tadas study, 12 patients were reviewed. All patients required secondary surgical procedures to address flexion contractures and angular deviation at the IP joint level. However, several primary factors contribute to the complexity of central polydactyly reconstruction. Hypoplastic joints and soft tissues that predispose the reconstructed finger to joint contracture, and angular deformities as well as complex tendon anomalies, are often difficult to address. Therefore, treatment is wholly dependent on the anatomic components present, the degree of syndactyly, and the function of the duplicated finger.
The current social communication domain criteria for autism diagnosis require individuals to have deficits across three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships. Communication deficits are due to problems with social-emotional skills like joint attention and social reciprocity.A range of social-emotional reciprocity difficulties (an individuals ability to naturally engage in social interactions) may be present. Autistic individuals may lack mutual sharing of interests, for example many autistic children prefer not to play or interact with others. They may lack awareness or understanding of other peoples thoughts or feelings – a child may get too close to peers (entering their personal space) without noticing that this makes them uncomfortable. They may also engage in atypical behaviors to gain attention, for example a child may push a peer to gain attention before starting a conversation.Older children and adults with ASD perform worse on tests of face and emotion recognition than non-autistic individuals, although this may be partly due to a lower ability to define a persons own emotions.Autistic people experience deficits in their ability to develop, maintain, and understand relationships, as well as difficulties adjusting behavior to fit social contexts. ASD presents with impairments in pragmatic communication skills, such as difficulty initiating a conversation or failure to consider the interests of the listener to sustain a conversation. The ability to be focused exclusively on one topic in communication is known as monotropism, and can be compared to "tunnel vision".