Reconceptualizing Somatic Dysfunction in the Light of a Neuroaesthetic Enactive Paradigm

Abstract

Background: Palpatory findings are considered a central element of osteopathic practice, especially when associated with a patient's altered regulative functions than with named somatic dysfunctions. Although osteopathic theories for somatic dysfunction could be plausible, the clinical applicability of the concept is debated, especially because it is largely related to simple cause-effect models of osteopathic care. In contrast to a linear kind of diagnosis of a "tissue as a producer of symptoms", this perspective article aims to provide a conceptual and operational framework in which the somatic dysfunction evaluation process is seen as a neuroaesthetic (en)active encounter between osteopath and patient. Subsections relevant to the subject: To summarize all concepts of the hypothesis, the enactive neuroaesthetics principles are proposed as a critical foundation for the osteopathic assessment and treatment of the person, specifically addressing a new paradigm for somatic dysfunction. Conclusions, and future directions: The present perspective article represents a proposition to blend technical rationality informed by neurocognitive and social sciences, and professional artistry clinical experience informed by traditional tenets, to overcome the controversy around somatic dysfunction, rather than dismissing the concept.

Keywords: Bouba/Kiki-effect; neuroaesthetic; shared decision making; somatic dysfunction; touch.

Figure A1

Clinical scenario 1.

Figure A2

Clinical scenario 2.

Figure A3

Clinical scenario 3.

Figure A4

Clinical scenario 4.

Figure A5

Clinical scenario 5.

Figure 1

Somatic dysfunction: the evolution of the concept.

Figure 2

Kiki and Bouba.

Figure 3

SFCT in the Neuroaesthetic Enactive perspective. The SFCT aims to produce a pleasant surprise (in the figure: patient perception of improved pain and motion of the right upper limb) and a significant prediction error that will defy prior assumptions and update the brain’s generative model (in the figure: I can go back playing tennis) by a nonverbal exchange between the patient and the osteopath, supported by narrative interactions.

Figure 4

SFCT algorithm: hypothesis formulation, validation phases and approach selection.