Trabajo Intermedio Grupal

Apellido / Nombre Integrante* DNI Carrera

Caporaletti Troilo, Julieta Milagros 41.503.785 Licenciatura en Psicología

Albornoz, Oriana Belen 44.532.170 Licenciatura en Psicología

Lust, Ariadna Soledad 42.576.356 Licenciatura en Psicología

Rodriguez Saracho Florencia Natalia 41.029.154 Licenciatura en Psicología

Santillán, Malena 42.647.761 Licenciatura en Psicología

*Aclaración: Para mejor orden cada estudiante debe realizar los comentarios sobre su fragmento dentro del cuadro correspondiente
como explicita el ejemplo.

Texto sobre el cual se ejemplifica el trabajo grupal:

[Link]
INTRODUCTION

Music therapists focus on the interaction between client and therapist and how listening and creating music functions within the
therapeutic relationship to achieve therapeutic goals.
The client is the focus of most case study research into the practice of music therapy; however, there is a lack of process-related
data in the music neurosciences that inform us as to what is happening during music therapy and how responses to music are
organised in situ [1]. There is now a well-documented body of evidence comprised of Cochrane reviews, systematic reviews, and
scoping reviews on the effect of music therapy on outcome measures of different intervention arms of randomised control trials
(RCTs), but neuroscience-informed process research into the mechanisms of change in music therapy is still underdeveloped [2].
Understanding how data in neuroscientific research is generated may help us to critically distinguish between models that explain
the context of human behaviour and its ecological validity, i.e., how much it represents transferability into everyday life [3]. The
laboratory is designed as an optimal measuring setting, reducing and controlling behaviour to elicit a target response, but it is here
that the problem starts. If we want to record what happens in everyday life, then we need to have settings similar to everyday life
[4]. The critique from some social scientists and anthropologists of lab-based behavioural-measuring procedures addresses the
situation and process of measuring itself, which have an impact on the quality of the data [5]. Humanistic critiques have been based
on the uniqueness and contextual nature of human experience, which is dependent on biographical time and place, as well as the
uniqueness of the situation in which subjects are involved [6]. Being in a concert or listening to music on the radio adds the
contextual dimension of personal experience in an ongoing situation onto perceptual processes. This influences intention and
selection of what has been heard, selected, and perceived consciously during perception. The influence of the experimental setting
in a laboratory is a critical issue, particularly when we consider how the subject regards his or her control of the situation.
“Not the objective control, as planned by the investigator, determines the changes of physiological measures but the subjectively
experienced influence (control) on the process by the subject” [7].
The present research project aimed to identify and tread new pathways for personalised research in the therapeutic professions. To
portray the clinical reality of the field, this project was designed to bring the laboratory into the clinical setting, rather than bringing
patients into the laboratory, as described in our protocol paper [8]. Concrete music therapeutic processes are at the focus of this
research. This should enable a deepened understanding of the mechanisms of relationship-oriented approaches to therapy based
on music therapy, which greatly values the knowledge-based practice of relationship-oriented therapy models.
“Simulated” conditions in music therapy research illustrate neither the reality nor the needs of therapists and patients and therefore
hinder the transfer of research outcomes to clinical practice. One of the resulting consequences is the amplified time lapse between
the creation of scientifically founded findings and their transfer into the clinical field [9]. Through the real-life application chosen for
this study, research findings are more directly translated into the practical work and flow more quickly back into the field.
Recent studies and reviews show the evidence and positive influence of music in neurorehabilitation after stroke or other acquired
brain injuries [10,11,12]. After experiencing a stroke, the world is different than it was before. What worked before may now be
limited, and must be learned and experienced anew. Music therapists grasp onto the individual capabilities, resources, and goals of
their patients and integrate these into their therapeutic work. Here, we focus on relationship-oriented approaches, as an in-depth
discussion of different approaches, their effectiveness, and evidence bases is beyond the scope of the current paper. The Krems
Concept of Music Therapy [13] underpinning this study can be summarised as a relationship-oriented and resource-oriented
biopsychosocial treatment concept. The personalised approach advocated through this concept does not place functional
limitations after a stroke at the focus of the therapy, but rather sets the goal of physically, as well as psycho-emotionally,
accompanying people after stroke through their recovery and new self-discovery process. The therapy can therefore include
functional exercises and regulative elements, as well as mental processing of the event.
In these relationship-oriented approaches, the therapist–patient relationship and joint musical participation are viewed as key
factors of effectiveness [14,15,16]. This is similar to psychotherapy research, in which the importance of the therapeutic relationship
and the therapist’s personality have been distinguished as the most significant factors [17,18,19]. The focus in relational
approaches in health treatments lies on a jointly created interactive process. Within this process, of particular importance are those
moments that have dialogical structures indicative of progress and change over the course of therapy [20,21,22,23]. These
moments of interest (MOI) in the therapy can contain several aspects [24,25], such as a musical meeting or a shared awareness or
perception of a (non)verbal interaction. The content of moments that are of importance and of interest for patients and therapists
may vary according to the situation and person. Daniel Stern and the Boston Change Process Group [26] describe these moments
in their research as “The Present Moment”. Several pieces of work have been dedicated to the exploration of qualitative
descriptions of such meeting or present moments in music therapy [20,27,28]. The therapeutic relationship involves a highly
dynamic interaction between patient and therapist [29]. When we interact with another person, our bodies and minds are not
isolated, but rather embedded in a joint domain with the other person, in which we become a dyadic unit through mutual
adjustments from moment to moment [30]. In clinical practice, music therapists experience that the impact of therapy manifests
precisely in some of these individual moments.

Aims of the Feasibility Study

Interdisciplinary research into the underlying neural processes of music therapy (MT), specifically of moments of interest as well as
the subjective experiences of patients and therapists, is largely lacking. One of the reasons for this is that there are no adequate
adapted methods to investigate and accompany such fragile and highly context-sensitive situations such as music therapy sessions
utilising improvisation and spontaneous therapeutic interventions [24]. Therefore, the aim of the current study was to assess the
feasibility of newly developed procedures to study the personal experiences and neuronal dynamics of moments of interest during
MT with stroke survivors in real-life situations.
Our overarching goal is to investigate which moments patients and therapists describe as interesting in the therapy and why, which
interactive behaviours can be observed, and whether a “meeting” takes place in these moments. In the electroencephalogram
(EEG), we are interested in which neurophysiological signatures can be identified, and whether there is a heightened
synchronisation of brain and heart activity occurring in these moments between patient and therapist. We assume that despite the
varying contents of MOIs, they may have underlying similarities in the dyadic neuro-cognitive-affective processes that are mirrored
in the neurophysiological correlates, especially when these moments are consciously shared and even experienced as moments of
meeting. It is expected this will be illustrated through the EEG in our research design and will be tested phenomenologically using
case studies [23,31]. To facilitate this process, our interdisciplinary research team (made up of music therapists, anthropologists,
and neuroscientists) developed a study protocol with a mobile lab, allowing for a real-life data collection setting directly in clinical
practice with a higher case base [8]. The research should stay as ‘close to practice’ as possible [32] and adapt itself to the patients
and the situation at hand [24], and not the other way around. Therefore, firstly, the MOIs must be identified during a therapy
session. To achieve this, therapy patients and therapists will be interviewed, and the method of ‘participant observation’ applied to
identify their individual subjective experiences, perspectives, and moments of interest.
For practice-based research in real-life settings, it is crucial that the interaction between therapists and patients can take place
naturally and be minimally influenced by any technology used for data collection. Moreover, the chosen imaging techniques must
be able to record the temporal components of MOIs, which change in the range of milliseconds. These requirements of temporal
resolution, though still enabling free movement, are currently only achieved with the EEG method. In our previous study [23], we
were able to analyse segments that were pivotal for the therapeutic change in the session and described corresponding peaks and
cross-correlations in the timecourse of a well-known neural marker of emotional processing (frontal alpha asymmetry, FAA). This
study suggested that the FAA is well-suited to the study of interpersonal music-therapeutic processes and that it is sensitive to the
temporal dynamics of dyadic emotional processes (for example, sharing emotional states, compassion, empathy). A further focus in
the present study will be placed on the exploration of synchronised brain activity which, for example [33], could represent a
neuronal mechanism allowing access to an internal state of another individual, and thus serve as the basis of shared emotions and
a shared understanding [29].
A dyadic electrocardiogram (ECG) recording provides the additional possibility of investigating any synchronisation of cardiac
parameters (heart rate, ECG amplitude) during MOIs. The analysis of dyadic music therapy processes as well as synchronisation
and resonance phenomena via ECG allows for comparison to other investigations of therapy processes using markers of the
autonomic nervous system. For example, in psychotherapy research, the non-verbal aspect of therapeutic interaction and social
conditionality of situational therapy effects have been explored using socio-physiological investigations of heart rate covariations
[34]. Currently, ECG synchronisation processes during psychotherapy are being investigated by windowed cross-correlations of
ECG time series [35]. In music therapy, Neugebauer and Aldridge [22] had previously explored changes in ECG during dyadic
improvisation. However, these investigations did not take place in clinical settings. Rather, the ECGs of healthy volunteers,
including MT students and therapists, were measured in a clinical improvisation-like situation. Therapy segments, which were
meaningful to the therapist according to their therapy summaries, were investigated using ECG and video for synchronous events.
Detecting and analysing therapeutic relational processes using psycho-physiological data has been advanced in some fields
(including neurorehabilitation) and shows the high potential of heart-rate variability (HRV) for demonstration and exploration of
physiological processes in music therapy [36,37,38].
Prior to the current feasibility study, we conducted eight dyadic test measurements with healthy volunteers (music therapy students)
in a controlled lab environment. The purpose of these recordings was to ensure sufficient synchronisation of the different data
streams (audio, video, EEG, ECG), which is needed for microanalytically analysing non-verbal interactions such as blinking and
mimicking. In addition, we needed to optimise the technical and practical procedures for use in a clinical context. After several
adaptations, an approximate duration for data collection in the clinic could be estimated, and a feasibility study with four to six
dyads (each with three music therapy sessions) was planned.
The goal of the feasibility study was to transfer and verify those experiences and procedures developed during the test
measurements, including previously developed data collection and imaging methods for describing MOIs in the process of music
therapy, and the technical procedures for EEG hyperscanning in the clinic. We did not know which moments the patients in phase
C of their neurorehabilitation would find interesting, whether the planned interviews were practically feasible to carry out, and,
similarly, whether the collected data could be included in the analysis, as was the case with the test measurements with healthy
volunteers. As such, we had to test and, if necessary, adapt the data collection process and the analysis strategy with the clinical
data. Salient to this process was getting to know the therapy rooms in which the measures would take place. The setup, camera
positioning, and details such as lighting and background noise influence the evaluation and precision of the analysis. In particular,
light and sound conditions can only be assessed in view of the video and audio materials.
INTRODUCTION (realizar los comentarios aquí)

Integrante 1
Troilo,
Julieta

Integrante 2 “The present research project aimed to identify and tread new pathways for personalised research in the therapeutic
Albornoz, professions”.
Oriana Esta oración presenta el objetivo de este trabajo de investigación, que es identificar y explorar nuevos caminos para la
investigación personalizada en las profesiones terapéuticas. Este objetivo tiene relación con lo planteado en la
investigación según su respectiva crítica a la falta de datos en estudios previos sobre los procesos neurocientíficos
que ocurren durante las sesiones de musicoterapia.

Integrante 3 “The client is the focus of most case study research into the practice of music therapy; however, there is a lack of
Lust, process-related data in the music neurosciences that inform us as to what is happening during music therapy and how
Ariadna responses to music are organised in situ”.
El conector “however” señala que se introducirá un elemento diferente al cual se han enfocado los estudios
existentes: el aspecto neurocientífico que informe qué es lo que sucede durante la musicoterapia y la organización de
las respuestas a la misma.

Integrante 4 “For practice-based research in real-life settings, it is crucial that the interaction between therapists and patients can
Rodriguez take place naturally and be minimally influenced by any technology used for data collection.”
Saracho Al utilizar la palabra “crucial” los autores refieren que , es fundamental que la tecnología utilizada para la recoleccion
Florencia de datos no interfiera en la relación entre terapeuta y paciente, permitiendo que su interacción sea lo más auténtica y
Natalia fluida posible

Integrante 5 Here, we focus on relationship-oriented approaches, as an in-depth discussion of different approaches, their
Santillán, effectiveness, and evidence bases is beyond the scope of the current paper
Malena Esta oración presenta uno de los objetivos del trabajo de investigación, que es centrarse en los enfoques orientados a
las relaciones. Nos marcan que se centraran en este enfoque y también que no van a considerar diferentes enfoques.
METHODS

Participants

In Austria, neurorehabilitation is structured into clearly defined phases (A to E), each linked with specific criteria, as defined by the
Austrian Society for Neuro Rehabilitation (OeGNR, [Link]
(accessed on 28 February 2022); for a comparison of stroke rehabilitation between European countries, see Putman and de Wit,
2009). According to this classification, patients in rehabilitation phase C are able to take part in therapies and activities for at least
three hours per day. Therefore, we decided to set up our design for phase C patients. For our research questions, patients’ ability to
verbally express themselves is crucial, whereas the time of the stroke was not important.
Inclusion criteria for the study were (1) stroke as the main diagnosis, (2) rehabilitation phase C, (3) minimum age of 18 years, and
(4) the ability to give consent. Exclusion criteria included aphasia or dysarthria, dementia (Mental State Test ≤ 24), post craniotomy
status, clouding of consciousness, somnolence, acute infections, drug or substance abuse, hearing impairment, uncontrollable
psychiatric issues (endangerment to self or others), or known allergies to the electrolyte gel or salt water.
The research team had access to patients’ medical data, such as the time of the stroke, affected brain region (using magnetic
resonance imaging data), medication, and therapies. Information on the person’s handedness, age, and education was also
collected.
Ethical approval for this feasibility study, which was conducted in accordance with the Declaration of Helsinki, was given by the
relevant ethics committee (Region Lower Austria GS1-EK-4/551-2018, Region Burgenland EK 88/2018). To participate, all
participants went through a thorough explanation of the study with a member of the research team, after which they gave informed
consent to take part.

Data Collection

Recruitment Sites Data collection was carried out in two facilities in different states of Austria. The first was an inpatient
neurological rehabilitation clinic (100 beds), where patients are regularly admitted and stay for three weeks for interdisciplinary
rehabilitation. Acute treatment is not available in this facility. The second facility was a Department for Neurology in a university
clinic (70 beds). In addition to acute medical treatment and diagnosis of various neurological illnesses, there are also inpatient
spaces for phase C rehabilitation. These spaces are normally claimed by patients after the acute phase (A + B) or offered as a
transition space until a rehabilitation space is available in the rehabilitation clinic. The duration of admission is therefore variable
and not always predictable.
Responsibility for individual steps in the recruitment process was shared between music therapists, medical doctors, and staff in the
therapy department. At initial examinations or patient visits, doctors were asked to screen participants according to the inclusion
and exclusion criteria and subsequently refer potential patients on to the music therapist. The music therapists carried out an
extensive briefing about the research project and answered any questions the patients had. When informed consent was obtained,
the music therapists informed the research team, who then scheduled an appointment for data collection (for an overview of
recruitment processes, see Figure 1).
Three music therapy sessions per patient were recorded over the course of the therapy (1× per week). In addition to the music
therapist, two Josef Ressel Centre (JRC) staff members were present during data collection. The tasks of staff members were to
set up the technical equipment, prepare participants for the EEG/ECG, carry out the recordings, monitor patients, and carry out
participant observation.

Feasibility of the Research Procedures For this study, it was important to investigate the duration and acceptability of the
investigation methods of the main study within the clinical context. The expected durations (based on our previous test
measurements-see above) are outlined in our protocol article [8]. Each course of data collection was planned to last approximately
190 min and is illustrated in detail in Table 1. The actual results and average duration of the procedures are included here.
Inspired by Orsmond & Cohn [39], as part of the feasibility study, any issues and suggestions were recorded in a log sheet
specifically created for this study (see Appendix A). Identified issues were also documented in field notes and addressed in detail in
the interviews. The log sheet was filled out during and after every course of data collection and includes the total duration as well as
the duration and acceptability of individual study procedures (for example, the EEG preparation, video rating, and MOI Interview),
difficulties or issues in the planning, communication and implementation of data collection in the clinic, comprehensibility of our
questions for participants, the observed burden for participants, as well as room for reflection and researchers’ comments.
Additionally, an anthropologist carried out participant observations during the data collection and logged the course of events and
any problem areas based on field notes. At the end of each course of data collection, participants were asked about their
experiences of the research setting and its procedures and whether they would participate again, as well as whether they would
recommend participation to others (see Appendix B).
Throughout the study, feedback was collected from staff in the clinic (administrative personnel, doctors, carers in the unit, music
therapists), and improvement suggestions for research processes as well as internal communication were taken on. In this way, the
acceptability of the additional organisational tasks should be maintained, and the smooth running of the study ensured.

EEG and ECG Recording For the hyperscanning of the patient–therapist dyad, mobile LiveAmp amplifiers (BrainProducts GmbH)
were used. These send data wirelessly via bluetooth to two recording computers and also save it to the amplifiers’ internal memory
cards. Simultaneously to the wireless EEG data transmission, a video is recorded by a camcorder, which is connected to the
recording computer via an analogue–digital video converter. The recording software Brainvision Recorder (BrainProducts GmbH)
receives both data streams and ensures a synchronous EEG-video recording.
In the first phase of the feasibility study, two different EEG caps were tested: 32-electrode gel caps (BrainProducts ActiCap) and
64-electrode saltwater-sponge caps (BrainProducts R-Net). The gel caps were placed on participants’ heads and subsequently
filled with electrolyte gel to improve the conductance. For the use of a 64-electrode saltwater cap, two 32-channel LiveAmp
amplifiers must be connected. The saltwater caps must soak in saltwater for 15 min before use and be put on the participants when
saturation is achieved. As soon as a good impedance level was achieved, the dyad took their places for music therapy. EEG was
recorded continuously throughout the therapy, with resting-state EEGs recorded at the beginning and end of the session (5 min
each). As a control condition, and to investigate the role of visual information and synchronous music playing for inter-brain
synchronisation, we asked participants after each session to play synchronously two drums with a tempo of 65 bpm (facing each
other and facing away).
The EEG recordings were monitored by the researchers on laptops. Synchronously to the EEG data, the EEG amplifiers recorded
two-channel ECGs. For this purpose, two electrodes were attached to participants’ upper body (right collarbone/left thorax) and
synchronously recorded using the LiveAmp amplifier and the “Stimulus and Trigger Extension Box” (BrainProducts GmbH,
Germany).
Planned EEG and ECG Analyses. The resting state EEGs will be analysed according to the power in various frequency bands
and undergo a before–after comparison. This is used, among other reasons, for the neurometric assessment of the z-score
deviations from a normative EEG database [40]. The analysis is based on the procedures implemented in the software
“Neuroguide” (recognised by the American Food and Drug Administration), which has been proven effective for use in the clinical
field [41,42]. The artefact cleaned, filtered and reliability checked (split-half, test-re-test) EEG will be split into two-second intervals,
with each interval subjected to a Fast Fourier Transformation (FFT). The obtained power values of the individual frequency bands
in each interval will be statistically tested for differences before and after music therapy using a t-test.
Emotionally relevant neural markers will also be investigated, including frontal alpha asymmetry (FAA) and frontal midline theta
(FMT). The FAA describes the relative strength in the alpha frequency band (8–13 Hz) in the left and right frontal lobes and
represents a neural marker of affective processes [43], which has previously been tested in the context of outcome-oriented music
therapy [44]. In process-oriented music therapy research, our own research of receptive music therapy is the sole investigation in
this area [23]. Here, we follow a similar approach, but with a higher case base and aim to extend FAA analyses with brain-to-brain
coupling measures, such as the integrative coupling index, measuring directional phase coupling across time [45].
ECG measurements will be investigated using heartrate synchronisation and other cardiac parameters such as ECG amplitude.
Due to the temporal synchronisation between ECG and videography, cardiac parameters can be considered during the analysis of
MOIs.

Participant Observation An anthropologist conducted a participant observation. The advantage of this method lies in the proximity
to the research participants, allowing context-specific phenomena to be captured directly. The manner and intensity of the
researcher’s immersion in this process are dependent upon the observation style [46]. To maintain the natural feel of the setting
while exerting minimal influence on the dyadic interaction between therapist and patient, an unstructured participant observation
was chosen. The participant observer was introduced to patients as a member of the project staff who was responsible for
monitoring recording technology and artefact control. Ongoing observations and (subjective) impressions were recorded in the form
of field notes.

Videography We implemented a video setup in which a patient and therapist work together sitting across from each other. In
addition to the synchronised EEG-video, three further video cameras were used. One of the cameras portrayed the “whole” of the
therapy session (patient and therapist both visible), and an additional camera was aimed at the individuals, respectively (patient
and therapist are each visible from the front).
The goal of this setup was, on one hand, to record the interaction between patient and therapist, and on the other hand, to record
the facial expressions of the individual participants. Three GoPro Hero4 cameras were used; these recorded synchronously using
an Arduino-based solution ([Link] accessed on 28 February 2022). Both EEG amplifiers received a synchronisation
marker that was manually elicited by the researcher through a button press. The button presses simultaneously activated a tone
generator and an LED, which was recorded by the cameras. Thus, all data streams included a common synchronisation marker.

Video Rating-MOI/MONI Selection After the EEG measures and subsequent experience screening (see Table 2 below) the
therapist and patient were separately asked to watch the video recording of the therapy session (on secured laptops) in its entirety,
and to individually choose between three to five moments that were interesting for each participant. Although it can be assumed
that more than three interesting moments may arise during therapy, out of practical reasons for the analysis, the number was
limited to 3–5 MOIs. To implement a comparison condition, participants were also asked if they could indicate at least one Moment
of No Interest (MONI). The exact start and end points of these moments were noted in a form. Participants could freely and
independently watch the video, with the audio playing through headphones, and navigate throughout it. Staff assisted with the
handling of the laptops as needed.
Planned Analysis of the Video Data. For the video analysis, the identified MOIs will be content-analysed in the video annotation
software ELAN (Eudico Linguistik Annotator) [47]. In ELAN, video data from different cameras can be analysed simultaneously.
Therefore, the different perspectives from the three cameras can be investigated both regarding the interaction between the
participants (whole), as well as the individual events at the microlevel (facial expressions, eye contact, movement). The aim is to
gain an overview and insight into the participant-chosen MOIs and to work out similarities and differences in the categories of
observation. For the analysis, it is also of interest whether there are periods in which the MOI selection overlaps between therapist
and patient.

Qualitative Interviews The interviews (experience screening and MOI interview, see below in Table 2) were carried out separately
with each participant, recorded with the help of a dictation device, and subsequently fully transcribed. Qualitative interviews allow a
way into study participants’ cognitive and subjective world of experience. Methodologically, we oriented ourselves towards the
episodic interview format, which can be attributed to Flick [48] and Helfferich [49]. Flick developed this interview method especially
for the evaluation of subjective concepts, combined with aspects of the narrative interview [50], and supported by an interview
guide. In this method, questions generated through narratives (stories) can be combined with open questions. Practically, this
means that, although direct questions are posed, the interviewees are also continually prompted to describe events from their
memories. This approach facilitated a sensitive interview adapted to patients’ and participants’ individual capabilities. Our chosen
style of semi-structured and guide-supported interviews (see Appendix C) has already been implemented successfully in other
studies with patients with stroke [51,52,53,54,55]. Three interviews were carried out at different times: the experience screening,
the MOI Interview, and the feasibility interview.
Experience Screening. In our personalised and participative approach, we are especially interested in the subjective angle, i.e.,
the views of therapists and patients and their lived experience of the therapy situation. Therefore, we carried out a short individual
interview with each participant directly after the music therapy session (after the EEG measurements), in which they could freely
recount how the session went for them and what they remembered.
MOI Interview. After the independent selection of three to five MOIs, both participants were asked about their selections. The
purpose of this was to examine the reasons for the selection, the meaning of the moments, and the qualitative experience thereof.
After all, three moments were described, participants were asked if one of these moments could be identified as a moment of
meeting (“… where a special connection between you and the person across from you occurred…”; see interview guide in
Appendix C). If not, the participant was asked whether a moment of meeting had occurred at a different time point. When this was
the case, patients gave a time indication and explanation for that moment. After the MOI discussion, both participants were given
the opportunity to name at least one moment that was not interesting for them (Moment of No Interest-MONI). These later served
as a comparison for the EEG analysis. Following each data collection, a feasibility interview was carried out; participants were
asked how they had experienced the research setting, if the instructions were easily comprehensible, and whether the use of the
computer was acceptable (see Table 2). After the last session, the patients were asked if they would take part in a study like this
again in the future.

Planned Analysis of the Qualitative Interview Data. Grounded theory [56,57] was chosen as the research approach for analysis
of the interviews and participant observations. This theory-generating process is described as “grounded” because all
interpretations arising from evaluation of the data are repeatedly considered in relation to the collected data, and thereby either
confirmed or adjusted. Through this continuous grounding of interpretations, it is confirmed that a theory can be developed further
in the research process and remains grounded in empiricism. The content of the transcribed interviews, as with the participant
observations notes, will be investigated, coded, and categorised. Collected data will be analysed in three ways in the coding
process, considering the field notes: open coding (aggregating phenomena into concepts and concepts into categories), axial
coding (investigation of the categories for similarities and differences), and selective coding (isolating of a central category) [56].
This method allows for inductive development of a fitting theory or construct of the identified phenomena. The advantage of this
method is the open and reflective approach.

Capturing the Readiness for Therapy Before each therapy session, participants filled out a questionnaire pertaining to their
readiness for therapy [58]. This took about 2 min. Patients indicated how ready they currently felt for therapy (11 items), and
therapists assessed how ready for therapy the patient seemed (6 items). The questionnaire used was developed in a parallel JRC
project that aimed to identify preferred treatment times using focus groups and participative research methods for and with patients
and therapists in Phase C neurorehabilitation. The questionnaire is currently being validated. Of interest for our project is whether
there is a relationship between respective therapy readiness and the emergence and quality of MOIs.

Combination of the Individual Methodical Approaches A profile of the MOIs will be developed from the interview data, the
participant observations, and the video analysis. Codes and categories from the interview analysis and participant observation will
be used as qualitative information and attributed to specific MOIs and input into ELAN. This process allows for the analysis of
subjective experience of the MOIs, with extracted descriptions contributing to a comprehensive profile of the MOIs. Subsequently,
the temporal punctuation of the identified qualia will be analysed in conjunction with parallel running of the physiological data from
EEGs and ECGs to describe neuronal and cardiac dynamics of the dyadic processes. This is how physiological markers of MOIs
will be extracted and connected to the participants’ experience during music therapy [23].
METHODS (realizar los comentarios aquí)

Integrante 1
Troilo,
Julieta

Integrante 2 “Inclusion criteria for the study were (1) stroke as the main diagnosis, (2) rehabilitation phase C, (3) minimum age of 18
Albornoz, years, and (4) the ability to give consent. Exclusion criteria included aphasia or dysarthria, dementia (Mental State Test
Oriana ≤ 24), post craniotomy status, clouding of consciousness, somnolence, acute infections, drug or substance abuse,
hearing impairment, uncontrollable psychiatric issues (endangerment to self or others), or known allergies to the
electrolyte gel or salt water.”
Esta oración hace referencia a los criterios que debe poseer la muestra de la investigación para poder ser incluida y/ o
excluida en el estudio tal como se expresa en “inclusion criteria for the study were” o en la expresión “Exclusion criteria
included”. Uno de los criterios de inclusión para la muestra compuesta por pacientes era poseer una edad mínima de
18 años, y por la parte de los criterios de exclusión no poseer alguna afasia o demencia.

Integrante 3 “The interviews (experience screening and MOI interview, see below in Table 2) were carried out separately with each
Lust, participant, recorded with the help of a dictation device, and subsequently fully transcribed. Qualitative interviews allow
Ariadna a way into study participants’ cognitive and subjective world of experience. Methodologically, we oriented ourselves
towards the episodic interview format, which can be attributed to Flick [48] and Helfferich [49”.
En esta cita se menciona la forma de llevar a cabo las entrevistas y la manera en la que son manipuladas luego. A su
vez, se justifica el uso de esta herramienta explicando su función. Por último, se menciona el enfoque metodológico
adoptado por los autores: el modelo de entrevista episódica de Flick & Helfferich.

Integrante 4 Experience Screening. In our personalised and participative approach, we are especially interested in the subjective
Rodriguez angle, i.e., the views of therapists and patients and their lived experience of the therapy situation. Therefore, we carried
Saracho out a short individual interview with each participant directly after the music therapy session (after the EEG
Florencia measurements), in which they could freely recount how the session went for them and what they remembered.
Natalia En este fragmento se refiere a la importancia que se le da a las experiencias subjetivas de cada participante en dicha
investigación. Es por esto que se llevaron a cabo entrevistas individuales, a terapeutas y pacientes,en las que cada uno
podia relatar su experiencia individual de las sesiones.
 Integrante 5 Ethical approval for this feasibility study, which was conducted in accordance with the Declaration of Helsinki, was given
Santillán, by the relevant ethics committee (Region Lower Austria GS1-EK-4/551-2018, Region Burgenland EK 88/2018. To
Malena participate, all participants went through a thorough explanation of the study with a member of the research team, after
which they gave informed consent to take part.
En esta cita se detalla en base a qué comité de ética dio la aprobación ética para el estudio. Forma parte de los
requisitos para ser parte del grupo de participantes. En este caso, firmar un consentimiento informado a posteriori de
recibir una explicación detallada del estudio con un miembro del equipo de investigación.

RESULTS OR FINDINGS

Recruitment and Sample Characteristics

Four study participants were recruited between October 2018 and June 2019 (mean post-stroke time of 11 months, range of 2
weeks to 29 months; mean age 62 years, range of 48 to 80). There was an interruption of three months due to a change of
therapist. Four music therapists carried out recruitment talks at the chosen study sites. Two out of the six patients at both facilities
who were asked refused to participate: one due to the presence of the researcher in the therapy room, and the other due to the
videography. One patient agreed to participate on the condition that they would not lose time in other therapies because of their
participation.
Due to organisational issues such as holiday plans, early discharge or acute care referrals (see Table 2 and for Questions Q1–4 in
Appendix B), only one patient was able to complete the three scheduled sessions. One patient was taken for acute medical
investigation during the first data collection, meaning only the second session could be fully recorded; all others participated in two
sessions.

Access to Patients in the Respective Facilities

For the minimal disruption of regular operations at the facilities, data collection was carried out on one day per week. Due to the
complexity of the mobile research setting and the duration of the research procedures (see Table 1), only one patient attended per
data collection day. Data collection was ideally carried out in two to three consecutive weeks. As a result, not all potentially eligible
participants were informed about the study and enrolled.
The music therapy room at the rehabilitation clinic turned out to be too small for the setup. Data recordings and therapy took place
in a training kitchen that was reorganised into a therapy room (for room layout, see Figure 2). The therapy room in the acute ward
was used by physio and music therapists and big enough for the setup. Equipment and furniture that were not used for the
research were hidden behind a room divider.
 Figure 2
Room layout of the mobile lab in the rehabilitation clinic.
Data Acquisition Methods
EEG and ECG Initially, the equipment (EEG and video cameras) was set up in the study participants’ therapy room. This took an
average of 43 min (range 30–60) for all four patients. Once set up was completed, patients were welcomed into the room. The
application of the EEG caps, ECG electrodes, as well as synchronisation of the video and EEG technology took an average of 39
min (range 18–65).
EEG Caps. The introduction of the new saltwater EEG caps noticeably shortened the preparation time by approximately 30 min.
The application of the gel-based EEG caps (patients 1 and 2) took about 30–45 min to complete, whereas the saltwater caps
(patients 3 and 4) were operational after about 5–15 min. Based on a first exploratory visual analysis of the EEG data quality, we
could not detect any systematic differences. There were no detailed remarks in the interviews that the EEG caps were perceived as
bothersome during music therapy sessions. The shorter application time for the saltwater caps was perceived by patients who had
previously worked with the gel-based EEG caps as an alleviating factor. Any potentially uncomfortable wetness of the saltwater cap
application was not noted. The experience of the saltwater cap was overall positive:

Patient: “And this new cap was also better than the one that I wore at the beginning […].”

Interviewer: “So, the cap was more comfortable.”

Patient: “The cap was more comfortable than the old one. Even though I wore it for a long time, it didn’t bother me, only then at the
end, it was maybe a little tight at the chin, but that was the only thing. Apart from that, not the cap itself. I didn’t feel it, as if I wasn’t
wearing one at all.”

EEG Amplifier. To be able to use the 64-electrode saltwater caps, two amplifiers must be connected for each person and worn by
the participants (width × depth × height: 8.3 cm × 5.1 cm × 1.4 cm; 60 g per amplifier). Backpacks proved not to be practical for
wearing the amplifier and the sensor and trigger extension box, as participants occasionally leaned on the backs of their chairs,
placing increased pressure on the equipment and plugs. Equally problematic was the use of hip bags, as the heat dissipation was
no longer adequately guaranteed.
To efficiently store all the technical appliances requiring close-to-body placement, and, above all, to make it comfortable for the
participants, we used light and comfortable so-called Fisherman’s vests (see Figure 3), through which freedom of movement was
not constrained and music therapy could proceed as usual. The equipment was placed into a pocket at hip-height. Two pockets
were used for therapists: the amplifier was placed in the side hip-pocket, and the batteries, sensor, and trigger extension box were
placed in the side chest-pocket.

Further, of importance were concerns regarding the quality of the wireless data transmission. Other wireless devices (such as
mobile phones, wireless speakers, etc.), as well as physical objects placed between the bluetooth receiver and the amplifiers, can
interfere with the signals. Therefore, all electronic devices had to be switched off (as well as the oven) and physical objects in the
transmission path were removed. To achieve a more stable bluetooth connection, we reduced the transmitted data by decreasing
the EEG sample rate from 500 Hz to 250 Hz. However, lost data samples due to connection errors were common and need to be
dealt with during the analysis stage.

3.4. Video
Synchronisation of the three GoPro cameras seemed not to work reliably or accurately with the Arduino-based solution (MewPro).
A prerequisite for a simultaneous start of recordings of all GoPro cameras was a stable power supply voltage, which was not
always supplied by the readily available USB-power adapters that we used. This resulted in unpredictable failures, e.g., of one
camera to start recording. Using a dedicated USP (uninterruptible power supply) box (Eaton 3S 550 DIN) alleviated this problem.
However, detailed analyses showed occasional asynchronies of the video and audio tracks, rendering the Arduino-based solution
not suitable for our purposes. In addition, analyses of recordings made without the Arduino-based solution indicated considerable
individual clock drifts in the GoPro cameras compared to the EEG. This was tested by comparing the intervals between two
consecutive synchronisation impulses recorded in the EEG data streams (trigger signals) and video streams (tone/LED signals).
The results of eight test recordings showed that, on average, the difference between intervals was around 140 ms, 140 ms, with a
minimal difference of ca. 80 ms and a maximal difference of approx. 580 ms (corresponding to ca. 8 frames on average, min 4
frames, max 35 frames). Results showed no consistent or systematic speeding up or slowing down in the GoPro video data, which
makes correcting the clock differences difficult. We therefore used the single-camera EEG-Video solution provided by the EEG
manufacturer.
When interviewing the therapists, it turned out that, depending on the therapeutic intentions, the restriction of movement (based on
the setup of the cameras mentioned above) was perceived as a potential influence on their therapeutic activities. We designed the
video setup to properly capture a sitting patient and therapist and to enable a distinct recording of the upper limb and head to follow
gaze and mimicking.
However, being audio-video (AV) and EEG recorded was unfamiliar for the therapists at the outset, but later in the process, they did
not notice the recording setup anymore. Interestingly, none of the patients mentioned the recording setup as problematic.

MOI Ratings
Patients selected between three and ten MOIs, but were always able to reduce these to the five to six most important ones (see
Table 3 for a detailed overview of MOI/MONI selections and durations). However, the duration of MOIs varied significantly, ranging
from 1 to 158 s. Finding MONIs proved to be difficult for patients, and no MONIs could be identified in half of the sessions. In
addition, the duration of MONIs also varied considerably, ranging from 3 to 147 s (see Table 3). Importantly, the MOIs selected by
the patients overlapped in seven out of eight sessions with therapist-selected MOIs, i.e., therapists and clients rated partly identical
segments of the session as being interesting (durations of overlaps ranged from 1 to 35 s).
Interviews
All interviews were carried out as anticipated. The experience screening took place right after the therapy/recording session and
lasted approximately 5 min for patients as well as therapists. The duration of the individual MOI interviews varied between 5 and 35
min for therapists (on average 18 min) and from 5 to 33 min (on average 18 min) for patients. In the MOI interviews, the participants
seemed motivated and engaged. Preliminary analysis of the first dyad indicated that patients did not always reveal the personal
meaning and emotional content of MOIs, meaning the interview stayed on a purely descriptive level. With further dyads, in
response to purely descriptive accounts, the interviewer explicitly asked after personal meanings to also include this perspective.
In the feasibility interviews (see Table 2 for individual responses to questions 1 to 4; see also Appendix B for feasibility questions),
patients showed interest and engagement and expressed their excitement for their participation in the research project. They fed
back that they felt they were in good hands and looked after throughout the process. The instructions and questions were clear and
comprehensible for the patients, despite any impairments. The patients experienced their participation in the research project as an
enriching change to the everyday routines of the clinic. They described their willingness to participate in a similar study again if they
felt they could offer a meaningful contribution to positive developments in neurorehabilitation after a stroke.
Feedback from one patient:
“First of all, you think to yourself that maybe something will come of it that could somehow help other people. And of course, you
also think of yourself, because you just think, maybe I will benefit from this myself through the music therapy that’s involved.”

Patient Burden through the Research

None of the patient interviews indicated overload or fatigue because of the technology and applications. One therapist had the
impression in a session that the patient was tired because of the lengthy application time (gel caps). From the perspective of the
participating observer (JV), there were indications of patient fatigue and decreasing energy level when the application (especially of
the gel caps) took a long time or when there were technical difficulties that needed to be solved urgently.
Measurements from resting-state EEGs before and after music therapy sessions, the EEG recording during music therapy, and the
comparison of back-and-forth synchronous drumming were not perceived as burdening or tiring. When the anticipated time frame
ran over (for example, due to technical problems with setup prior to the therapy session), and participants had other appointments,
or if the patient was noticeably tired or unfocused, the synchronous drumming was left out (see Table 2).
RESULTS OR FINDINGS (realizar los comentarios aquí)

Integrante 1
Troilo,
Julieta

Integrante 2 “However, the duration of MOIs varied significantly, ranging from 1 to 158 s. Finding MONIs proved to be difficult for
Albornoz, patients, and no MONIs could be identified in half of the sessions. In addition, the duration of MONIs also varied
Oriana considerably, ranging from 3 to 147 s (see Table 3)”.
Las tablas en la sección de resultados permiten presentar gran información y datos más comprensibles mediante datos
numéricos presentes en columnas o filas. Posee relación con el contenido presente en los resultados de las entrevistas
 y los momentos de interés y desinterés, destacando en la tabla la variación significativa de los resultados.

Integrante 3 Preliminary analysis of the first dyad indicated that patients did not always reveal the personal meaning and emotional
Lust, content of MOIs, meaning the interview stayed on a purely descriptive level. With further dyads, in response to purely
Ariadna descriptive accounts, the interviewer explicitly asked after personal meanings to also include this perspective.
Este fragmento expresa uno de los posibles contratiempos que se pueden presentar en este tipo de investigaciones:
los pacientes no siempre revelan cuestiones personales o emocionales, lo cual lleva la entrevista a un nivel puramente
 descriptivo que, en este caso, no es a lo que se apunta. Por este motivo, se hace mención a la forma de afrontar estas
situaciones, preguntar explícitamente aquel detalle de interés.

Integrante 4 None of the patient interviews indicated overload or fatigue because of the technology and applications. One therapist
Rodriguez had the impression in a session that the patient was tired because of the lengthy application time (gel caps). From the
Saracho perspective of the participating observer (JV), there were indications of patient fatigue and decreasing energy level
Florencia when the application (especially of the gel caps) took a long time or when there were technical difficulties that needed to
Natalia be solved urgently.
En este fragmento, los autores resaltan el hecho de que ninguno de los pacientes tuvo algun tipo de malestar frente a
la tecnologia utilizada en el estudio. Aunque detallan que pueden cansarse en los momentos en que surgian
inconvenientes y los pacientes mostraban cierta fatiga en momentos de dificultades tecnicas.

Integrante 5 When interviewing the therapists, it turned out that, depending on the therapeutic intentions, the restriction of movement
Santillán, (based on the setup of the cameras mentioned above) was perceived as a potential influence on their therapeutic
Malena activities
Esta oración expresa que en la investigación encontraron que la restricción del movimiento se percibía como una
posible influencia en sus actividades terapéuticas. Volviendo a hacer énfasis en su enfoque en las relaciones, como
planteaban en la introducción del documento.

DISCUSSION
This feasibility study allowed us to test the procedures of a newly developed mobile setup with EEG, ECG, and video, as well as
qualitative video ratings and interviews in a real clinical environment with persons after a stroke.
An important observation was that patients did not experience any negative restrictions from the EEG application, nor increased
burden due to the interview and video rating procedures, which was encouraging. Analysis of the feasibility interviews, intended to
collect responses on the burden or stress of the participants, showed that patients were interested and curious about taking part in
the study, and reported that the participation was a welcomed variety to their routines in rehabilitation and music therapy that was
experienced as enriching their rehabilitation, as the following quote from a patient demonstrates:
“Well, I think at the beginning I thought to myself, music therapy, how is that supposed to help me, because I’ve always been so
focused on being able to move my arm and my leg and now somehow, I can see that music therapy can also contribute to
improving my condition.”

Selecting MOIs
To our knowledge, patients in neurorehabilitation have not previously participated in the analysis of their own sessions. Video
analysis is a common tool used in music therapy practice and research, but the videos are mostly analysed by experts, and
interviewing participants has not yet been included [59]. In microanalytic research, it is common to triangulate between different
rater perspectives [60], and a recent scoping review suggested that the patient perspective is of importance for understanding
change processes in therapy [2]. To realise this kind of research setting, a patient must consent to being videotaped (one screened
patient did not agree to this; see 3.1 above), revisiting the therapy session, and they must be able to verbalise.
The interviews revealed that most patients were not used to reflecting and talking about their experiences after therapy. This was
obvious in the first MOI interviews of patients, which were short superficial descriptions of the intervention, e.g., “This was when the
therapist sang this song”—without talking about subjective experiences, thoughts, or emotions. After the first two sessions, the
research team started to ask further questions to move more deeply into the qualitative experiences of each patient. The timing and
duration of the interviews proved to be appropriate, only leading to minor changes in the interview guideline by posing the question
of the experience of the research setting at the end.
The selection of MOIs was feasible for all participants. Patients did not report any stress during watching and rating the video,
perhaps also due to the cooperative atmosphere that we were striving to create during the data collection procedures. Watching the
video was not intended to be part of the therapy process or to developing therapy goals together, but only to select the MOIs. All
therapists were used to the analysis of videos of their own therapeutic practice as a didactic and reflective tool during their training
and were able to select three to five MOIs in each session.
The large difference in duration between patient- and therapist-selected MOIs might seem surprising, but it is consistent with a
long-standing discussion in music therapy about how to define a moment and how long a moment is. Further, what constitutes a
moment is and how long it is, is not necessarily clear, as moments in therapy are related to participants and their therapists.
Chronological measures do not capture what is discussed as kairologic experiences and the specific situated content of that
process [24]. Therapists have come up with an array of potential descriptors, such as resonance, synchronicity, and affect
attunement [28,61]), but the generalisation of what constitutes a moment has not yet been achieved and is based on different
interests. However, a common denominator is that each of such moments, regardless of its duration, belongs to a therapeutic
narrative of change [62], and there have been several attempts to systematise them. Wosch and Wigram [63] have discussed
microanalytic approaches to define segments, episodes, and sections of the timeframes selected, and researchers have focussed
on the musical content, for example, of particular motifs that engaged the patient and labelled them accordingly [64,65]. Here, we
have accepted that patients offered us their specific choice of what they found interesting and also how long they attributed it to
being interesting. The specific duration here is of interest for our time-based analyses of behavioural and neural processes.

Research Setting
Conducting research in a naturalistic setting obviously has trade-offs compared to a controlled setting in a laboratory, and requires
a certain balance between what is possible and feasible in the field and what is interesting from a theoretical point of view. In our
mixed method approach, we have tried to support phenomenological descriptions with quantitative data on a (neuro-)physiological
level (EEG and ECG), to increase the validity of our qualitative data (participatory observation and interviews). Such an approach
has already been realised in studies of healing settings “in the field” [23,66,67,68]. Qualitative research emphasises a natural
setting and encourages data collection, including measurements, in those places where events take place in daily life [69,70].
In this project, we have tried to keep the music therapy and its setting in a rehabilitation centre as natural and authentic as possible.
Nevertheless, there are obvious differences, since it is a therapy happening within the framework of a research project where data
collection takes place at the same time, using various technical equipment and the presence of additional researchers. In the
course of our participant observations, and according to the statements of the participants, wearing an EEG cap, amplifier, and
ECG electrodes was only marginally distracting at the beginning of the first session of the therapy. However, the distraction
gradually disappeared and had no remarkable impact on the process of the therapy itself. It was important for the participants,
especially for the patients, to be properly informed about the research setting and what is going to happen, in order to get the
feeling of “being in good hands”—this fact enabled them to completely engage in the therapy. It was noticeable and reported by the
music therapist that essential therapy elements and themes took place, as is usually the case within a therapy session. For
example, patients were able to open themselves up and talk about very personal topics, indicating that they experienced MT as a
safe place. This observation encourages us that it is possible to study clinical reality with our approach.
However, bringing the ‘lab to the field” can also imply focussing on a common aspect of children’s music therapy in a laboratory
research setting. A recent study [71] was creating an experimental setting that resembled a setting in which parents would join an
MT session or watch a session behind an observation window while waiting. The researchers measured the dual-EEG of a child
and the parent, while the parent watched the facial expressions of their child participating in the music therapy on a video screen in
another room. The parents “had exclusively a frontal view of the faces of their children. This design was adapted to emulate current
clinical practice” [71] (Samadani et al., 2021, p. 3). This research setting allowed good data recording control (at least on the side of
the sitting parent) and enabled analysing the interbrain synchrony between parent–child dyads while parents were observing their
child’s facial expressions. However, their study did not investigate therapist–patient interaction, but investigated an (non-interactive)
aspect of the child–parent relationship in an experimental research setting situated in music therapy.

Rehabilitation Settings Recruiting patients for this study was feasible. However, this feasibility study did not aim to assess a
sufficient number of patients for a randomised controlled study. Rather, it aimed at assessing the feasibility of a lifeworld-orientated
EEG–ECG hyperscanning procedure in clinical practice.
When scheduling music therapy research sessions, we made sure that patients did not miss other treatments. This was possible
due to good cooperation with the persons responsible for therapy planning. However, data collection on three consecutive weeks
was not always possible due to organisational constraints. For the main study, the holiday plans of the music therapists and
scheduled medical examinations of the patients will be considered to ensure full data collection with each dyad. Two screened
patients in the rehabilitation facility declined to participate due to the videography and participatory observation part of the research.
However, enough patients fulfilled the inclusion criteria in the rehabilitation facility; therefore, the refusal of screened patients did not
impede patient recruitment and the research schedule. In the rehabilitation ward of the university clinic, it took more time to find
patients who fulfilled the inclusion criteria due to the severity of acute symptoms or patients being close to being discharged.
Regarding the practicability of this kind of research project, the rehabilitation facility, with its well-regulated daily routines, was more
suitable than the acute hospital ward due to unpredictable medical events, examinations, and emergencies. In an acute medical
setting, the focus is primarily on containing traumatic events and the assessment of medical, nursing, and acute-therapeutic issues,
in which music therapy contributes. One session had to be interrupted due to a spontaneous medical examination of the patient,
which was scheduled by the hospital during the time of data collection. Patients’ exact length of stay also could not be predicted,
which impacted recruitment as well as data collection, and, as a result, the desired three consecutive weekly sessions.
An advantage for our project was that one of the researchers was familiar with both research settings. She had worked there before
as a therapist, knew the team members and their responsibilities, as well as the organisational structure, and was able to consider
potential challenges and pitfalls in the planning of the study. Staff from both organisations were involved in the planning phase to
carefully and reasonably split tasks between members and to ensure the study ran smoothly. Before starting the feasibility study,
the final processes of patient examination, assignment to music therapy, personal pre-consultation, and recruitment were presented
to the teams, and we made sure that everybody knew what to do and how to find all the information needed for his/her task. In the
rehabilitation clinic, continuous feedback during the course of the study was positive and the acceptance of the study was high.

EEG Technology
For the transportation of the equipment, two suitcases and several bags were used. Two members of the research team were
present for each data collection. Compared to a lab setting, in which technological procedures can be controlled more easily, a
mobile setting for each participant is prone to problems that may occur. However, these instances were not as often as expected.
The technical realisation of this dual-EEG-ECG video setup for a real-life setting in a clinical ecology proved to be challenging. One
promising synchronisation development with three small 4k cameras showed no reliable frame-based synchronisation results and
could not be used for EEG-ECG video synchronisation. For our purposes, we were able to use the single video camera EEG setup
provided by the EEG vendor. However, having multiple cameras (with different video perspectives on interactants) can be beneficial
for detailed behaviour analyses that do not require highly accurate synchronisation.
EEG application, cap comfortability, and body-carried EEG amplifiers should not influence the therapy experience. However, one
therapist experienced the setup as restricting, as she would have used more activities involving movement with her patient. The
amplifiers were situated in the side-pockets of the Fisherman’s vests as shown in Figure 3, but it might be better to have vests,
which would allow carrying the amps on the back in shoulder pockets; however, such vests were not available. During experience
screening and interviews, none of the patients mentioned that the EEG procedures were exhausting for them. The transition from
the gel caps to the saltwater caps saved time, as well as simplified the implementation of the research project for research staff and
participants.
For the follow-up study, we plan to use the same analyses (evaluation of the before/after resting-state EEG, synchronisation of
brain activity; for details, see the study protocol of the feasibility study in Fachner et al., 2021) [8]. As is explained elsewhere [23],
we will focus on frontal alpha asymmetry as an indicator of emotional valence.
Music therapy focuses on therapist–patient interactions, in which moments of empathy and emotional connection can occur [72],
which then can promote motor rehabilitation and lead to an improvement in functional outcomes [73]. In a case study deriving from
this feasibility cohort focussing on MOIs and their FAA timeseries [74], we were able to demonstrate how emotional processes, as
shown in the FAA were aligning between therapist and patient, an observation that we described already earlier in a different
therapy setting (Fachner, Maidhof et al., 2019) in which a strong emotional impact on the patient is shared with the therapist. The
in-depth observation of this case study also confirms that we were able to record MOI EEG data in the field that is not only
personally meaningful, but also has a sufficient data quality that allows further analyses. Apart from the analysis of shared
emotional processing in the main study, we are interested in analysing directed brain-to-brain coupling [75], how MOIs and MONIs
differ across sessions and dyads, and how this relates to the interactional content and emotional qualities.

Limitations and Outlook

Though receiving three weekly music therapy sessions reflects the rehabilitation pathways of our inpatients in the
neurorehabilitation clinics, patients in other settings often receive more than three sessions, which in turn can alter patients’
experiences and the therapeutic relationship. It remains to be seen whether the acceptability of the research procedures might
change over a longer course of music therapy.
Although we are interested in dyadic processes, more than two persons were present in the music therapy room. This was
methodologically necessary to allow for participatory observation (see Section 2.2.4 above), but none of the participants mentioned
this as being distracting. Thus, we assume that the presence of other persons has a rather negligible influence on
(music-therapeutic) dyadic processes.
Another more general limitation inherent in real-world approaches that investigate unconstrained, naturally occurring interactions,
such as those in the present study, is the question of the functional significance and interpretability of EEG findings. Though these
data have a high ecological validity, they presumably reflect a multitude of simultaneously occurring dyadic cognitive and affective
processes that interact in complex ways. Nevertheless, our recent study [23] suggested that real-world (music therapy) data can be
meaningfully interpreted, and future studies can combine this explorative and hypothesis-generating research with “naturalistic
laboratory research” [76].
At these early stages of research, we can only speculate what the clinical applications could be. However, a potential optimisation
of personalised music therapy assessment and delivery is conceivable, for example, with the help of automated detection of MOI
instances based on neural descriptors of patient engagement, therapeutic insight, emotional intensity, and regulation. We agree
that “an understanding of neural synchronization processes during music therapy sessions could be a crucial and viable tool for
high-quality therapy sessions” (Kang et al., 2022, 5f) [77]. The clinical implication of process- and outcome-related social
neuroscience research for the horizon of personalised medicine and music therapy seems thus to be manifold and promising, in
various clinical fields. This is in line with a recent position paper, claiming that the use of EEG hyperscanning in individuals with
neurological diagnoses, such as stroke, is “particularly relevant and could provide additional insight on neural dynamics, optimising
rehabilitation strategies for each individual patient” (Short et al., 2021, p. 1) [78]. Whereas these authors focus on the advantage of
investigating functional gains of interventions with hyperscanning, we are demonstrating how EEG hyperscanning can be used for
process research in a naturalistic music therapy setting delivering active music therapy that focuses on the actual personal needs
of the patient.
DISCUSSION (realizar los comentarios aquí)

Integrante 1
Troilo,
Julieta

Integrante 2 “An important observation was that patients did not experience any negative restrictions from the EEG application, nor
Albornoz, increased burden due to the interview and video rating procedures, which was encouraging.”
Oriana Esta cita refiere a un hallazgo u observación importante realizada respecto a los pacientes que no experimentaron
restricciones negativas a la aplicación de EEG (electroencefalograma). Esto respalda la metodología utilizada en la
investigación.

Integrante 3 “Though receiving three weekly music therapy sessions reflects the rehabilitation pathways of our inpatients in the
Lust, neurorehabilitation clinics, patients in other settings often receive more than three sessions, which in turn can alter
Ariadna patients’ experiences and the therapeutic relationship. It remains to be seen whether the acceptability of the research
procedures might change over a longer course of music therapy.”
Al utilizar la frase “it remains to be seen”, los autores expresan el enfoque de una posible investigación: los cambios
frente a una musicoterapia de mayor duración.

Integrante 4 The interviews revealed that most patients were not used to reflecting and talking about their experiences after therapy.
Rodriguez This was obvious in the first MOI interviews of patients, which were short superficial descriptions of the intervention,
Saracho e.g., “This was when the therapist sang this song”—without talking about subjective experiences, thoughts, or
Florencia emotions.
Natalia En este fragmento los autores resaltan que las entrevistas demostraron el hecho de que los pacientes no tenían el
hábito de compartir en profundidad lo que vivieron durante la terapia. En las primeras entrevistas, sus respuestas
fueron bastante superficiales, limitándose a describir lo que pasó en la sesión, pero sin expresar cómo se sintieron.

Integrante 5 Nevertheless, our recent study [23] suggested that real-world (music therapy) data can be meaningfully interpreted,
Santillán, and future studies can combine this explorative and hypothesis-generating research with “naturalistic laboratory
Malena research” [76].
 En esta oración se presenta una propuesta de orientación para futuras investigaciones, presentando la idea de que los
estudios futuros pueden combinar esta investigación exploratoria y generadora de hipótesis que se presenta en el
documento con una “investigación de laboratorio naturalista”.

CONCLUSION

In this study, we reported on the feasibility of implementing a mobile EEG hyperscanning and AV lab into a naturalistic clinical
setting of music therapy in neurorehabilitation. To bring the ‘lab into the field’, we had to adapt some technical procedures, and we
tested different AV data recordings to arrive at a feasible level of data quality. The recruitment of participants and implementing the
research setting were easier in a neurorehabilitation clinic, because there are different routines and demands compared to an acute
setting. The acceptability of the research in the rehabilitation clinic was high, and the staff was open to further studies. Patients did
not report any extra burden placed on them, experienced the research as a welcomed diversion from their daily hospital routine, felt
safe and secure with the team, and were happy to be part of a research project that may help other patients in the future. Thus,
future research with this approach in rehabilitation settings seems feasible, and further research in this domain is warranted.

CONCLUSIÓN (realizar los comentarios aquí)

Integrante 1
Troilo,
Julieta
Integrante 2 “In this study, we reported on the feasibility of implementing a mobile EEG hyperscanning and AV lab into a naturalistic
Albornoz, clinical setting of music therapy in neurorehabilitation.”
Oriana Esta oración se refiere al argumento clave presentado en la investigación el cual consistia en implementar un
hiperescaneo EEG móvil y un laboratorio AV en un entorno clínico naturalista de musicoterapia en
neurorrehabilitación de manera novedosa, en relación a investigaciones anteriores respecto al tema en cuestión.

Integrante 3 “Thus, future research with this approach in rehabilitation settings seems feasible, and further research in this domain
Lust, is warranted.”
Ariadna Con la implementación del conector “thus”, los autores refieren a que lo previamente mencionado es justificación para
la próxima afirmación: son posibles futuras investigaciones con el enfoque utilizado en este estudio.

Integrante 4 The recruitment of participants and implementing the research setting were easier in a neurorehabilitation clinic,
Rodriguez because there are different routines and demands compared to an acute setting
Saracho Los autores resaltan el hecho de que organizar el estudio y el reclutamiento de pacientes fueron pasos sencillos en
Florencia una clinica de neurorehabilitacion por las dinamicas y necesidades menos exigentes en ese tipo de entorno, a
Natalia diferencia de situaciones de atencion más urgente.

Integrante 5 Patients did not report any extra burden placed on them, experienced the research as a welcomed diversion from their
Santillán, daily hospital routine, felt safe and secure with the team, and were happy to be part of a research project that may help
Malena other patients in the future
Esta cita expresa que los participantes estaban felices de ser parte de un proyecto de investigación que puede ayudar
a otros pacientes en el futuro, recomendando así como una experiencia agradable para los mismos y que podría y
sería beneficioso volver a incluir pacientes en futuras investigaciones, por lo que podría considerarse una sugerencia
para una futura investigación.