Embodied-enactive clinical reasoning in physical therapy

Abstract

Clinical reasoning is essential in physical therapy practice. Instrumental approaches and more recent narrative approaches to clinical reasoning guide physical therapists in their understanding of the patient's movement disturbances and help them to plan strategies to improve function. To the extent that instrumental and/or narrative models of clinical reasoning represent impairments as mere physical disturbances, we argue that such models remain incomplete. We draw on a phenomenologically inspired approach to embodied cognition (termed "enactivism") to suggest that the dynamics of lived bodily engagement between physical therapist and patient contribute to and help to constitute the clinical reasoning process. This article outlines the phenomenologically informed enactive perspective on clinical reasoning, with special reference to clinical work that addresses impairments as sequelae of neurological diseases.

Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors

“…The lived experiences of the patients before and after their neurological lesion were essential to the IBITA instructors understanding of the patient as a person and their patient's movement problems. Thus, the individual patient can be understood as inactively engaged, an agentive body as suggested by Oberg et al …”

“…The manipulation of sensory information in the broadest sense, known as facilitation, has been identified as a key feature of Bobath clinical practice . Oberg et al discuss facilitation as enhancing “shared agency,” ie, making an activity or task possible that the patient cannot yet do alone, and an important feature of therapeutic practice to be able to potentiate independence in daily activities. The co‐construction of the clinical interaction by the IBITA instructors and utilization of implicit and explicit forms of communication, termed “intercorporeity,” suggests an embodied intersubjective aspect to the reasoning process …”

Enactive Approach and Dual-Tasks for the Treatment of Severe Behavioral and Cognitive Impairment in a Person with Acquired Brain Injury: A Case Study

“…Currently, these theoretical stances are a primary line of research in non-Cartesian cognitive sciences (Rowlands, 2010): such as philosophy, (Gallagher, 1986, 1995, 2000, 2005; Johnson, 1987; Gallagher and Zahavi, 2008; Shapiro, 2011), neuroscience (Varela et al, 1991; Damasio, 1994, 2003; Thompson and Varela, 2001; Edelman, 2004), psychology (De Jaegher, 2013; McGann et al, 2013), education (van der Schyff, 2015; Lozada and Carro, 2016), and artificial intelligence (Clark, 1998). And although these types of studies remain scarce in the rehabilitation sciences, there are some publications based on this theory, such as studies regarding the rehabilitation of persons who suffer from an experiential disorder called hemiphobia (Martínez-Pernía and Ceric, 2011) and embodied-enactive clinical reasoning in physical therapy (Øberg et al, 2015). …”

Towards a Phenomenology of Self-Patterns in Psychopathological Diagnosis and Therapy

“…In such cases, we can say that the processes that lead to these detailed descriptions or narratives are not private mental procedures, but intersubjective, interactive accomplishments. This kind of intersubjective narrative dynamic has direct application to clinical reasoning in various medical and therapeutic practices – physical medicine, psychiatry, physical therapy, psychotherapy [131, 132]. …”