Neurophenomenological Rehabilitation: Reconceptualizing Recovery as the Expansion of the Autopoietic System

Autopoiesis, originally developed by Maturana and Varela, has been influential across multiple disciplines, but its application to rehabilitation medicine remains theoretically underdeveloped. This paper proposes Neurophenomenological Rehabilitation, a theoretical framework for understanding recovery not as the restoration of isolated bodily functions, but as the reorganization and expansion of the patient’s embodied autopoietic system. Drawing on Kawamoto’s system phenomenology, it interprets Sich as the operative organization of sensory relations, Selbst as the bodily articulation of that organization, Umwelt as the meaningful environment correlated with the system’s mode of action, and System as the recursive interaction between embodied organization and environment. In this framework, the therapist mediates the therapeutic process by participating in the recursive interaction constituting the patient’s System and supporting the emergence and stabilization of new sensory relations. As these relations become incorporated into the patient’s body schema, they may become pre-reflective bodily capacities through which environmental differences acquire practical significance within the patient’s Umwelt . The framework is also placed in dialogue with cognitive therapeutic approaches, narrative medicine, personalized medicine, and One Health, which offer complementary resources for addressing cognitive, experiential, individualized, and environmental dimensions of rehabilitation and health. Neurophenomenological Rehabilitation thus offers an analytical framework for understanding how such resources may contribute to autonomous reorganization, rather than a uniform or empirically validated clinical protocol.