Therapeutic touch and therapeutic alliance in pediatric care and neonatology: An active inference framework

Therapeutic affective touch has been recognized as essential for survival, nurturing supportive interpersonal interactions, accelerating recovery—including reducing hospitalisations, and promoting overall health and building robust therapeutic alliances. Through the lens of active inference, we present an integrative model, combining therapeutic touch and communication, to achieve biobehavioural synchrony. This model speaks to how the brain develops a generative model required for recovery, developing successful therapeutic alliances, and regulating allostasis within paediatric manual therapy. We apply active inference to explain the neurophysiological and behavioural mechanisms that underwrite the development and maintenance of synchronous relationships through touch. This paper foregrounds the crucial role of therapeutic touch in developing a solid therapeutic alliance, the clinical effectiveness of paediatric care, and triadic synchrony between health care practitioner, caregiver, and infant in a variety of clinical situations. We start by providing a brief overview of the significance and clinical role of touch in the development of social interactions in infants; facilitating a positive therapeutic alliance and restoring homeostasis through touch to allow a more efficient process of allostatic regulation. Moreover, we explain the role of CT tactile afferents in achieving positive clinical outcomes and updating prior beliefs. We then discuss how touch is implemented in treatment sessions to promote cooperative interactions in the clinic and facilitate theory of mind. This underwrites biobehavioural synchrony, epistemic trust, empathy, and the resolution of uncertainty. The ensuing framework is underpinned by a critical application of the active inference framework to the fields of pediatrics and neonatology

The role of the vagus nerve during fetal development and its relationship with the environment

The autonomic nervous system (ANS) regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. Several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors (i.e. fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure) may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses.Comment: Word count: 16,009 Tables: 1 Figures:

An externalist approach to creativity: discovery versus recombination

What is the goal of creativity? Is it just a symbolic reshuffling or a moment of semantic extension? Similar to the contrast between syntax and semantics, creativity has an internal and an external aspect. Contrary to the wide- spread view that emphasises the problem-solving role of creativity, here we consider whether creativity represents an authentic moment of ontological discovery and semantic openness like Schopenhauer and Picasso suggested. To address the semantic aspect of creativity, we take advantage of recent externalist models of the mind suggesting that the mind is more than symbol recombination

A New Mind for a New Aesthetics

While the extent of the dependence between theories of aesthetics and models of the mind is a matter of lively debate, it is fair to claim that current approaches to consciousness suggest new perspectives about the nature of aesthetic experience. Recent findings of neuroscience have affected how we see aesthetics and art. Nevertheless, while it is often suggested that neuroscience will soon offer a comprehensive account of the nature of mind and thus of aesthetic experience, here we consider the consequences on the recent theoretical bifurcation as to where mind is located (namely the externalist vs. the internalist stance). From such a view, the issues of unity and meaning are used to probe into the nature of aesthetic experience and art. The discussion draws upon William James’ distinction between nucleus and fringe and puts forward a converging perspective between psychology, phenomenology and neuroscience. Eventually, art is exploited as a window to peer inside fundamental aspects of mental life by means both of recent brain imaging results and more extended models of the mind