ABSTRACT NUMBER: ESOC2026A84 PATIENT–THERAPIST COGNITIVE ENGAGEMENT AND PATIENTS’ FINGER VELOCITY DURING MUSIC THERAPEUTIC INTERACTION IN STROKE REHABILITATION: AN EEG–MIDI BASED PILOT RCT

Abstract Background and aims Real-time motor improvements are often observed in post-stroke patients during Music Therapy (MT) sessions involving patient-therapist Music Therapeutic Interaction (MTI), yet real-time mechanisms remain unclear. This study aimed to examine associations between patients' and therapist's Cognitive Engagement (CE) and patient finger velocity (key-pressing force) of the impaired hand. It also explored differences across musical exercise order and type (structured vs. unstructured; playing with the therapist vs. alone), to further understand MT mechanisms in stroke rehabilitation. Methods Thirty post-stroke patients were randomized into two groups differing in the order of two interactive patient-therapist piano-keyboard-based exercises: Piano Learning and Free Improvisation. All sessions opened with a Baseline exercise (patient's playing alone). CE of patients and the therapist was measured with the EEG-based Cognitive Effort Index (CEI), and patients' finger velocity was measured using a MIDI keyboard. Results A moderate positive patient-therapist CE correlation emerged only during Piano Learning, suggesting greater attentional alignment in structured context. Patient CE did not differ across exercises or orders. Patients' finger velocity was significantly higher during both interactive exercises compared to Baseline. The first interactive exercise elicited the highest velocity regardless of type. Higher patient CE was associated with lower velocity, suggesting cognitive–motor trade-off. Conclusions Findings were interpreted through neurocognitive, motivational, relational, and embodied perspectives, showing that patients' motor performance was shaped by patient-therapist MTI, exercise type, and order. The cognitive–motor trade-off reflects the multidimensional nature of MT tasks, highlighting MT unique contribution to stroke rehabilitation. Video excerpts will demonstrate findings. Conflict of interest Name of author: nothing to disclose