McParlin Zoe, Cerritelli Francesco, Rossettini Giacomo, Friston Karl J, Esteves Jorge E
Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.
School of Physiotherapy, University of Verona, Verona, Italy.
Front Behav Neurosci. 2022 Jun 30;16:897247. doi: 10.3389/fnbeh.2022.897247. eCollection 2022.
Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops "priors" necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding - and explaining - the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically - to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others - through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments.
触觉被认为对生存至关重要，它能促进合作交流、加速康复、缩短住院时间，并促进整体健康和治疗联盟。在这篇假说与理论论文中，我们提出了一个交织模型，该模型将用于校准的触觉与主动推理相结合，以解释大脑如何形成医疗保健提供者与患者有效互动所需的“先验”。我们借助主动推理来解释通过触觉支持同步关系的经验性综合神经生理和行为机制。具体而言，我们提供了一个正式框架，用于理解和解释治疗性触摸及实践护理在肌肉骨骼护理中建立治疗联盟以及医疗保健提供者与患者之间同步性方面的作用。我们首先回顾治疗性触摸的关键重要性及其在促进稳固治疗联盟形成和调节全身适应性方面的临床作用。然后，我们从主动推理的角度考虑触觉在临床上的应用方式——促进合作交流、表达同理心、克服不确定性以及推断他人的心理状态。我们得出结论，触觉在实现成功的临床结果以及调整先前的先验以形成交织信念方面起着关键作用。由此产生的框架可能有助于肌肉骨骼护理领域的医疗保健提供者利用实践护理来加强治疗联盟，将预测误差（又称自由能）降至最低，从而促进身体和心理损伤的康复。
