The visual occipito-temporal cortex is composed of several distinct regions specialized in the identification of different object kinds such as tools and bodies. Its organization appears to reflect not only the visual characteristics of the inputs but also the behavior that can be achieved with them. For example, there are spatially overlapping responses for viewing hands and tools, which is likely due to their common role in object-directed actions. How dependent is occipitotemporal cortex organization on object manipulation and motor experience? To investigate this question, we studied five individuals born without hands (individuals with upper limb dysplasia), who use tools with their feet. Using fMRI, we found the typical selective hand-tool overlap (HTO) not only in typically developed control participants but also in four of the five dysplasics. Functional connectivity of the HTO in the dysplasics also showed a largely similar pattern as in the controls. The preservation of functional organization in the dysplasics suggests that occipito-temporal cortex specialization is driven largely by inherited connectivity constraints that do not require sensorimotor experience. These findings complement discoveries of intact functional organization of the occipito-temporal cortex in people born blind, supporting an organization largely independent of any one specific sensory or motor experience.T he visual occipito-temporal cortex contains multiple domainsensitive regions (1) that are highly reproducible across individuals. Much is known about these regions' large-scale organization. Consistent with the patterns of neuropsychological dissociations showing a fundamental distinction between animate and inanimate objects (2, 3), neuroimaging results have shown that the animate/ inanimate distinction is the primary organizational dimension in the occipito-temporal cortex (4-8), with a secondary distinction within the inanimate domain between navigation-relevant (e.g., large nonmanipulable objects and scenes) and small, manipulable inanimate objects (9-12). What are the principles that guide this organization? One possibility is that it is the direct result of experience, critically dependent on the individual's life experiences and expertise (13)(14)(15)(16)(17)). An alternative is that experience merely modulates an already existing innately determined structure, driven by connectivity constraints (4, 18-21) between regions within the occipito-temporal cortex and downstream areas specialized in processing specific object types.A notable example supporting the close link between visual form processing and its downstream use is a specific region in the occipito-temporal cortex that shows spatially overlapping preferences for hands and tools (22,23). This overlapping specialization is obviously not based on visual similarity alone because hands and tools are visually quite distinct. Nor is it due to general domain specialization because animate and inanimate objects are otherwise distinct (24-26). Instead, the overlap may ...