Annals of the New York Academy of Sciences

The pleasurable urge to move to music - known as groove - has been linked to rhythmic and harmonic complexity via an inverted-U relationship, consistent with predictive coding theory of music. This link has been demonstrated mainly in Western listeners, leaving its cultural generality unclear. Given reports of heightened pitch and harmony sensitivity in Chinese listeners, we predicted stronger responses to harmonic complexity and weaker responses to rhythmic complexity compared with Western listeners. We conducted two online experiments measuring "pleasure" and "wanting to move" ratings for musical excerpts varying in rhythmic and harmonic complexity, comparing Chinese and Danish participants as representatives of Eastern and Western traditions. In Experiment 1, which manipulated both dimensions, both groups showed inverted-U responses to rhythmic complexity, but Danish participants exhibited a sharper curve, indicating greater affective differentiation. No inverted-U pattern emerged for harmonic complexity, and Chinese participants did not show enhanced harmonic sensitivity. Experiment 2 focused on rhythmic complexity using ecologically valid stimuli with finer gradations. Again, Danes showed greater sensitivity to rhythmic variation, reflected in a sharper curvature of their inverted U responses, though peak responses did not differ between groups. Our findings support the universality of predictive responses to rhythmic complexity, while highlighting the modulatory role of cultural exposure in shaping musical affective experiences.

Sensorimotor synchronization, the ability to align motor behaviour with the temporal structure of external stimuli, is thought to emerge gradually during development, but its origins remain unclear. Here, we investigated whether newborns can adapt their sucking behaviour and synchronise it to the temporal structure of auditory stimuli within the first days of life. Forty-one healthy full-term newborns (24-72 hours old) were exposed to two three-minute auditory streams differing in temporal structure: a highly structured stream with a stable temporal pattern and a highly variant stream with greater temporal variability, while their non-nutritive sucking (NNS) was continuously recorded. We assessed changes in NNS frequency and pressure and quantified NNS-sound coupling using magnitude-squared coherence at frequencies distinctive to each auditory stream. Structured stimulation promoted a more organised NNS, with more suck bursts than the variant stream, and increased sucking vigour, with a transiently higher suck peak rate during the first minute relative to the variant stream and greater suck pressure relative to silence. Coherence analyses revealed that coherence was selectively higher at the frequencies distinctive to each auditory stream, both for the structured and the highly variant stimulus. These findings show that, within hours of birth, NNS behaviour can selectively align with stimulus-specific temporal regularities, even when these are weakly predictable and lack a dominant periodicity. This early capacity to extract temporal structure and coordinate motor behaviour may provide a foundation for the subsequent development of sensorimotor synchronisation.

Humans coordinate their actions while their bodies and brains synchronize in social interactions, yet how behavioral, physiological, and neural dynamics interact during interpersonal coordination remains largely unknown. We investigated how respiration and individual differences influence behavioral and inter-brain synchrony in a musical synchronization task, which requires precise temporal alignment. Eighty-eight individuals first produced a familiar melody at their most comfortable rate to measure their spontaneous production rate (SPR). They then synchronized the melody with a randomly assigned unfamiliar partner under natural (unpaced), instructed in-phase, and instructed anti-phase breathing conditions, while hyperscanning 64-channel electroencephalography (EEG), respiration, auditory-motor timing, and perceived social connectedness were recorded. Relative to natural respiration, both in-phase and anti-phase breathing increased inter-brain phase-locking and perceived social closeness but reduced behavioral synchrony; the instructed respiratory phase relationship was mirrored in their inter-brain relative phase. Differences in phase of respiratory cycles (inhalation and exhalation) also influenced coordination: Inhalation was associated with stronger inter-brain synchronization but less precise and stable behavioral coordination than was exhalation. Moreover, Individual differences influenced coordination: Partners with the faster SPR consistently preceded the slower partners and exhibited an alpha-band inter-brain phase advance in synchronization, whereas dyads with similar SPR showed greater behavioral synchrony and smaller inter-brain phase difference. Our findings identify respiration as a previously overlooked factor that organizes behavioral and neural synchronization, while individual intrinsic rhythms constrain how interacting partners align in time. Together, these findings reveal a dynamic interplay between the rhythms of the body and brain during human social interactions.

Interpersonal physiological synchrony (IPS) between interaction partners has been studied as a marker of social connectedness and coordination. However, little is known about how such interpersonal synchrony relates to the intrapersonal coordination of individuals' own autonomic systems during team interaction. The present study examined whether IPS and intrapersonal physiological synchrony (IAPS), defined as the within-person coordination of heart rate (HR), respiration, and electrodermal activity (EDA), function as competing or complementary regulatory processes. It also examined whether IAPS is state- or trait-like and whether teams high or low in both IPS and IAPS had better outcomes. Fifty five newly formed triads (N = 165; Mage = 23.87, 77% female) participated in a laboratory interaction including passive shared experiences and active collaborative tasks while continuous physiological activity was recorded. Synchrony within individuals and between team members was quantified using multidimensional recurrence quantification analysis. Across interaction segments, IAPS was positively associated with IPS in both HR and EDA, with stronger and more consistent associations during active teamwork versus during passive social contexts. These findings contradict a trade-off hypothesis and instead support a synergistic relationship between IAPS and IPS. IAPS exhibited state-like dynamics and sensitivity to features of the context, i.e., consistency within similar interaction contexts and higher in passive versus active social segments. Further, IAPS had limited associations with individual difference measures. Exploratory analyses indicated that teams characterized by both high IAPS and high IPS demonstrated more favorable outcomes, reflected in either higher objective task performance or greater perceived team efficacy depending on physiological modality. Together, these results suggest that effective team coordination is supported not only by IPS but also by the capacity to maintain coherent internal autonomic organization. They further highlight IAPS as a dynamic component of social functioning that merits exploration alongside interpersonal processes.

Social bonds are essential for well-being, and moving together to music is a universal means of promoting prosocial behavior and positive affect. However, the functions and interpretations of movement synchrony and music can vary across cultures and may depend on personal values. We examined how interpersonal synchrony and music affect social bonding in participants from individualistic (Denmark, N = 137) and collectivistic (China, N = 226) cultures. Participants watched videos of virtual stick figures - representing themselves (virtual-self) and an unknown person (virtual-other) - moving either synchronously or asynchronously to music or a metronome. After each video, participants rated three indicators of social bonding: their momentary feeling of social connectedness with the virtual-other (Inclusion of Other in the Self, IOS), likeability of the virtual-other, and well-being as the virtual-self. Personal values were measured using the Portrait Value Questionnaire. Music and synchrony promoted all three indicators of social bonding in both cultures, whereas cultural differences emerged in asynchronous conditions. Chinese participants rated the asynchronous virtual-other more likeable than Danish participants, aligning with the collectivistic emphasis on social harmony. Moreover, Chinese participants rated their own well-being higher than Danish participants when the virtual-self moved asynchronously, suggesting greater self-forgiveness in maintaining group harmony. The personal values of benevolence, conformity, and universalism interacted with movement synchrony and cultural background, underscoring the important role of values in interpretations of social interactions. Our findings highlight the universal prosocial effects of music and movement synchrony, while also emphasizing cultural nuances in how these effects are experienced.

Semi-occluded vocal tract (SOVT) exercises are widely used in voice training and therapy, but their immediate electroglottographic (EGG) effects remain incompletely characterized. In this pilot methodological study, six female community singers completed a no-straw baseline recording and then 1-min straw-phonation exercises with four straws (Household metal, Metal VoiceStraw, plastic, and paper), each followed by a no-straw EGG recording. Thirty 1s recordings were analyzed with a standardized pipeline including contact quotient (CQ), waveform skewness, contact-phase rise/fall timing, temporal skewness (s_t), a normalized derivative asymmetry index (NDAI), average-cycle morphology, and EGG spectral descriptors. Relative to baseline, group-mean CQ was higher after all four straws (by 0.027-0.058), waveform skewness and NDAI were lower, and the EGG spectral centroid was lower (by 9.6-15.3%). Contact-phase timing asymmetry did not change consistently: s_t exceeded baseline after three straws and fell below it after one, and the rise/fall ratio decreased in three to five of six participants depending on the straw. Four participants ranked the Metal VoiceStraw first and two ranked paper first. Because every straw condition followed the baseline, warm-up and order effects cannot be separated from straw effects. These hypothesis-generating results identify CQ, waveform skewness, and EGG spectral centroid as candidate endpoints for a larger controlled study

Discourse analysis can reliably predict real-world communicative success, yet is rarely implemented clinically, due to challenges in manually generating stimulus-specific main concept inventories (MCIs) and scoring patient narratives. We evaluated whether automatically derived macrolinguistic (main concept, sentiment) and microlinguistic (fluency, lexical, syntactic) features extracted from movie clip narrations can augment the clinical assessment of discourse in aphasia. The MCIs generated directly from each clip's video, audio and subtitles using a vision-language model approximated the main concepts healthy controls produced. Group classification (control: n=51; aphasia: n=54) based on the discourse features was excellent (AUC=0.95, 95% CI [0.90, 0.99]), with macrolinguistic features showing the largest group differences (main concept completeness: d=-1.84, 95% CI [-2.30, -1.38]) and strongest associations with aphasia severity (semantic distance to inventory: r=-0.79, 95% CI [-0.87, -0.66]). Findings support the feasibility and scalability of automated criterion-based discourse assessment using ecological stimuli, and highlight its potential for clinical implementation.

The photic sneeze reflex (PSR), in which exposure to bright light triggers sneezing, is widely recognised but inconsistently defined and measured. We conducted the first systematic review and meta-analysis of PSR prevalence to synthesise the epidemiological evidence, assess methodological quality, and identify priorities for future research. We included 18 articles comprising 31 study groups and extracted prevalence estimates, study characteristics, ascertainment methods, and epidemiological information. Fifteen eligible study groups classified as healthy were included in the primary meta-analysis. The pooled prevalence was 22% (95% CI, 15%-29%), with extreme between-study heterogeneity (I2 = 99.3%). Reported prevalence estimates and associations with participant characteristics varied widely, and nearly all studies were judged to be at high risk of bias. The pooled estimate should therefore be interpreted as a descriptive summary of the available evidence rather than a precise estimate of population prevalence. Future studies require a standardised operational definition, representative sampling, transparent reporting, and reproducible methods for assessing light-triggered sneezing.

Background: Prolonged mechanical ventilation is associated with inspiratory muscle weakness and difficulty weaning from respiratory support. While decades of research have demonstrated that inspiratory strength training (IST) is beneficial in adult critical care populations, the literature on its use in pediatric cardiac critical care remains limited. We sought to evaluate the feasibility, safety, and physiologic response to IST in children in the pediatric cardiac intensive care unit (PCICU). Methods and Results: We performed a single-center retrospective cohort study of children with congenital heart disease referred for IST between January 2015 and August 2021. Feasibility was defined as completion of [≥]1 IST session following referral. Safety outcomes included physiologic events documented during IST sessions. Changes in maximal inspiratory pressure (MIP) were assessed in patients who completed [≥]2 IST sessions. Of 105 eligible patients, 93 (89%) successfully completed at least 1 IST session. Monitoring events were reviewed across 389 IST sessions and included pre-oxygenation (62%), desaturations (13%), bradycardia (7%), and hypertension (2%). All events were transient and did not require escalation of care. 84% of patients were successfully liberated from mechanical ventilation and required a median of 2 (IQR 1-4) sessions of IST. Among patients completing [≥]2 IST sessions, MIP improved signicantly over time (p>0.0001). Improvements were observed in both patients who did and did not wean from mechanical ventilation. Patients who failed to wean from mechanical ventilation had longer ventilator exposure prior to IST initiation and were more sedated at the outset of IST. Conclusions: IST was feasible and well tolerated in this medically complex PCICU cohort. High completion rates and improvements in MIP support the use of IST as a clinically deliverable intervention that can produce measurable improvements in inspiratory muscle strength during critical illness.

Touch moderates how we interact with objects, others, and ourselves, where self-touch is particularly important in self-care, although fewer studies have investigated its perception, especially with age. Here, women aged 20-28 and 65-75 years rated how self-applied creams felt on the cheek and forearm, using sensory and emotional descriptors in the Touch Perception Task. Factor analyses uncovered higher tactile dimensions, including Texture, Moisture, Positive Affect, and Negative Affect. Sensory dimensions were more intense in the young group, whereas Positive Affect was stronger in the older group. We then used network and clustering analyses to map how the descriptors interacted. Young participants showed significantly higher connectivity between descriptors, whereas older participants displayed fewer connections, but many became mixed sensory-emotional pairings. Clustering analyses revealed further changes in the tactile groupings with age. We conclude that aging reshapes touch into an emotionally-rich experience, which impacts how interact with ourselves and others.

Background Mirror therapy (MT)-specifically paradigms using mirror visual feedback (MVF)-is widely used in neurorehabilitation; however, mechanistic implementations vary substantially in movement content, rhythmicity and attentional demands. This protocol describes an acute mechanistic, within-participant fNIRS screening study designed to compare three prespecified upper-limb mirror-therapy task paradigms and to quantify associated subjective experience after each condition in healthy adults during a single visit. Methods and analysis This is a single-centre, within-participant, randomised crossover study conducted at Wuhan Wuchang Hospital (Wuhan, China). Healthy adults aged 18-35 years will complete three task conditions once each in a counterbalanced order using a 3*3 Latin-square scheme: UMT1 (task-oriented rhythmic functional movement), UMT2 (open-ended free movement with auditory control), and UMT3 (non-functional rhythmic movement). fNIRS will be acquired using the NirSmart-6000A system during a standardised block design. The primary outcome is ROI-level HbO activation quantified as GLM-derived {beta} estimates within the prespecified primary ROIs (bilateral SM1/M1 and bilateral PMC). Secondary outcomes include ROI-level windowed {Delta}HbO (5-20 s post-onset relative to the immediately preceding rest; descriptive only), ROI-level {Delta}HbR, and post-condition subjective ratings (illusion, immersion, confusion and fatigue; 1-7 Likert). Condition effects will be analysed using linear mixed-effects models with fixed effects for condition and period and prespecified multiplicity-adjusted pairwise contrasts. Ethics and dissemination Ethics approval was obtained from the Ethics Committee of Wuchang Hospital Affiliated to Wuhan University of Science and Technology (Approval No.: 2025-112-01; approved on 2025-08-21). The study is expected to be minimal risk. Findings will be disseminated through publication of this protocol manuscript and subsequent results manuscripts and conference presentations. Trial registration number Chinese Clinical Trial Registry (ChiCTR2600116634). This study is conducted as a prespecified mechanistic sub-study under the overarching registered project.

Humans coordinate in groups, yet much of what we know about coordination comes from dyadic interaction. In groups, however, how much people synchronize may not be enough. Pairwise synchrony can be distributed across teammates: who synchronizes with whom, and how these connections are distributed, may carry distinct social information. Here, we tested whether physiological group synchrony can be understood as a network topology of interpersonal coordination rather than as an aggregate of dyadic alignments. A total of 33 groups (N = 161 participants) completed cooperative and competitive joint drumming tasks while cardiac inter-beat intervals (IBI) and electrodermal activity (EDA) were recorded simultaneously. Pairwise physiological synchrony was estimated using lagged cross-correlation and used to construct synchrony-based networks. IBI-based networks showed stronger and broader cardiac connectivity during cooperation, with cardiac coupling also increasing during competitive drumming relative to baseline. EDA-based networks also showed task-sensitive changes in node-level connectivity and captured social and behavioral dimensions of group interaction, linking trust and cohesion to node-level connectivity, and collective behavioral synchrony to lower clustering and higher local efficiency. Together, these findings show that the social meaning of physiological group synchrony lies not only in how much individuals align, but in how physiological alignment is distributed across people, relationships, and biological systems. By preserving this configuration, synchrony-based network analysis captures information about group experience that is lost when synchrony is reduced to an average dyadic score, providing a route toward understanding group synchrony as a flexible, selective, and distributed property of social coordination.

Chronic social deficits (persistent feelings of being lonely or isolated) have been linked to premature mortality, yet the underlying physical and mental pathways remain unclear. This study used data from 4,090 older adults in the English Longitudinal Study of Ageing, a longitudinal panel study. Using outcome-wide analyses, we assessed how the chronicity of social deficits was associated with 17 health outcomes across physical, mental, cognitive and behavioural health domains. Regression models showed that chronic loneliness was longitudinally associated with increased risks of worse general health, functional capacity, and mental wellbeing, and more unhealthy behaviours. Chronic isolation and onset of isolation were associated with lower quality of life, whereas isolation remission was positively related to enhanced mental wellbeing and cognition compared to no isolation. Findings suggest an association between chronicity of loneliness and adverse health outcomes, highlighting chronic social deficits as an important correlate of healthy ageing.

Collective social events often require coordinated action by one group to become shared experience in another, yet how this transformation is organized across multiple brains remains unclear. Live music provides a tractable model of this problem because ensemble coordination, performer-audience alignment, and shared audience integration unfold within the same event. Here we tested whether performer-audience neural coupling acts as a cross-role neural interface linking ensemble coordination to shared audience integration. We recorded brain activity from a nine-person live performance system, consisting of a fixed three-performer ensemble and four independent audience groups, using synchronized multi-device functional near-infrared spectroscopy hyperscanning across live trio performance sessions. Inter-brain neural coupling was analyzed across three relational layers: performer-performer (PP), performer-audience (PA), and audience-audience (AA) coupling. Behavioral ratings showed strong affective engagement and shared evaluative alignment. Neural coupling during live performance was not expressed as a diffuse increase across channel pairs, but was organized into task-sensitive relational components with interpretable PC-corr network modules. Crucially, path-based mediation analyses revealed that PA components statistically bridged PP coordination and AA coupling, yielding multiple complete and partial PP [->] PA [->] AA pathways. Brain-behavior analyses further suggested that mediation-related PA components were linked to shared performance evaluation and emotional alignment. These findings identify performer-audience coupling as a cross-role neural interface through which coordinated production becomes linked to shared collective reception. Significant StatementHow coordinated actions become shared experiences is a major problem in social neuroscience, yet most studies examine pairs of people. Using live music as a model of group interaction, we found that brain-to-brain alignment was organized across social roles rather than arising as a uniform response to the same event. Performer-audience alignment occupied a bridging position between coordination within the ensemble and integration within the audience. This identifies a systems-level architecture through which collective action may become linked to collective experience. The framework moves multi-brain research beyond dyads and offers a general approach for studying classrooms, public speaking, theater, rituals, and team events, where one group generates structured behavior that another group jointly receives and interprets.

Interpersonal movement coordination is a foundational feature of human sociality, scaffolding communication, affiliation, and joint action from infancy onward. Whether this behavioral coupling is accompanied by genuine coupling between brains, rather than one manufactured by shared sensory input or motion artifact, has proven difficult to establish. We recorded dual-brain EEG with synchronized head-mounted accelerometry from participant-partner dyads (16 dyads, 155 dyad-condition recordings) across six conditions grading interpersonal coordination from stillness to fully reciprocal joint movement, using improvisational dance to elicit sustained, naturalistic, gradable coordination. Windowed cross-correlation confirmed graded, partner-specific movement coordination, including a lead-lag signature that reversed with who led. Against a pseudo-dyad surrogate, inter-brain synchrony took one specific form: amplitude-envelope coupling in the high-beta and gamma bands, robust to a leakage-corrected measure, with no phase-based or slow-band coupling. Within dyads, movement synchrony predicted the strength of this amplitude coupling (standardized beta = 0.54 in gamma), an association that strengthened monotonically with frequency, held under a dyad fixed-effects estimator, and was undiminished when the amount of movement was entered into the model. Movement synchrony and inter-brain coupling also co-fluctuated within interactions, above surrogate. Two control analyses excluded the leading alternatives: the coupling was not sensorimotor rhythm-tracking, since corticokinematic coherence was present but non-localized and not movement-selective, and not a shared movement-frequency rhythm linking the brains. These results identify interpersonal movement coordination as an organizing variable for inter-brain coupling and specify that coupling as fast-band amplitude co-modulation, not phase synchrony. Brains couple when bodies coordinate, not when they merely move together.

Questions What is the effectiveness of a prenatal educational physiotherapy intervention in reducing the prevalence of positional occipital plagiocephaly (POP) and POP-associated disorders in infants at 3 months of age? Design Two-arm assessor-blind multicentre, randomised controlled trial. Participants 400 pregnant women Intervention The experimental group received specific physiotherapy educational session on POP prevention strategies during the regular antenatal education class meeting. The oblique diameter difference index (ODDI) is the primary outcome. Secondary outcomes included musculoskeletal POP-associated conditions. Results Three hundred twenty-eight newborns completed the study. The ODDI scores showed no statistically significant difference between the groups at 3 months (mean difference -0.28 [95% CI: -0.72 to 0.17; p = 0.218]). The prevalence of POP did not differ between the two groups (21.1% in the intervention group, 22.2% in the control group), which is lower than data reported in the literature (37.8% - 46.6%). No statistically significant between-group differences were found in secondary outcomes, except for spinal postural asymmetry (aRR = 0.95; 95% CI: 0.90 to 0.99; p = 0.031). There were no significant differences in the caregiving strategies adopted during the first three months of life. Conclusion A low POP prevalence was observed, with no statistically significant differences between groups, as both groups adopted preventive strategies. The lack of superiority of the structured education may suggest a shift in parental education. With more health information on social media and the global ease of sharing, parents have relied on digital self-treatment, reducing the intervention's impact; thus, the face-to-face model for low-risk infants may be outdated.

Head-eye coordination during ball interception depends on both task demands and motor experience. The purpose of this study is to determine how these factors influence head-eye contributions to gaze control. Twenty-five female university students (novices with no ball sport experience, n = 13; experienced softball players, n = 12) performed two tasks: visually tracking an approaching ball (tracking task) and, in addition, moving the hand to the ball's landing position (reaching task). Head, eye, and gaze velocities, cross-correlation coefficients between gaze and head velocity, and gaze-head lag time were analyzed using linear mixed models. The results showed that although gaze velocity remained unchanged regardless of tasks or groups, decomposing gaze into head and eye components revealed task-dependent contributions. Compared with the tracking task, the reaching task showed significantly larger head velocity and smaller eye velocity, indicating complementary adjustments that were not revealed by gaze movements alone. The cross-correlation between head and gaze was significantly higher in the reaching task than the tracking task, indicating stronger temporal coupling under greater task demand. Furthermore, the experienced group showed greater task-dependent modulation of eye velocity than the novice group, demonstrating greater flexibility in adjusting the magnitude of head-eye movements to task demands. In addition, the experienced group showed a consistently near-zero gaze-head lag regardless of task, whereas the novice group showed a prolonged gaze-leads-head interval. These findings suggest that ball sport experience shapes two distinct aspects of head-eye coordination: task-dependent flexibility in movement magnitude, and stable, temporally synchronized gaze-head control.

The mental health and wellbeing or `mind health', which we define as the ability to navigate challenges and function productively, of adolescents has declined substantially over the last two decades corresponding with fundamental changes in their daily environments. These include the widespread adoption of smartphones and social media as well as reduced sleep and time spent in nature. Device free, nature-rich summer camps represent a shift in environment that has been shown to have behavioral and mental health benefits. However, neural mechanisms underlying these changes remain unknown. Here we examined EEG spectral and complexity measures in adolescents ( N=30) before and after a three-week device-free, nature-rich residential summer camp. Following the intervention, participants exhibited steeper aperiodic slopes, increased DFA scaling exponents, reduced entropy and Lempel-Ziv complexity, and decreased alpha and beta power, a convergent pattern consistent with a shift toward more structured or less random neural dynamics characterized by relatively greater inhibitory influence. These neural changes co-varied with reduced restlessness and hyperactivity, improved focus, sleep quality, and overall mind health in a subsample (N=23) with both EEG recordings and self-reported mind health data. Precision analyses further confirmed the specificity of this relationship. Subjects who showed EEG changes beyond a defined threshold showed improvements in mind health metrics with high precision up to 100\%. Our findings demonstrate that the benefits of device-free, nature immersion with peers extend beyond self-reported mind health to measurable shifts in underlying brain dynamics, suggesting that exposure to device-free natural environments supports adolescent neural and psychological health. Trial registration : ClinicalTrials.gov NCT07761143.

Musical training produces behavioral gains that extend beyond the practiced context. Yet, it is unclear whether such generalization is accompanied by broadly transferable neural changes or whether training-induced plasticity remains tied to the specific features of the learned material. In this study, 80 musically naive adults completed four piano-training sessions and underwent functional MRI before and after training. Twenty untrained participants served as passive controls. Participants performed a passive listening task in which they listened to the trained melody (Fur Elise) and an untrained melody (Ode to Joy), each played on a trained musical instrument (piano) and an untrained musical instrument (saxophone). Following training, participants demonstrated improved accuracy and rhythmic performance when playing an unfamiliar melody, indicating behavioral generalization. Training-induced neural changes, however, were predominantly associated with the learned melodic content. Listening to Fur Elise elicited increased activity in the intraparietal and supplementary motor cortex and in the cerebellum, as well as decreased activity in the superior temporal cortex. Consistently, pre- and post-training scans were most accurately classified based on brain activity to Fur Elise played on piano or saxophone, rather than brain response to Ode to Joy, suggesting that neural reorganization was driven more strongly by the practiced melody than by the trained instrumental timbre. Training also enhanced the neural separability of both melodic and instrumental information. Critically, pre-training responses to Fur Elise played on the piano predicted subsequent playing accuracy, whereas pre-training sensitivity to instrumental timbre predicted rhythmic performance in a novel melodic context. Together, these findings suggest that while acquired musical skills behaviorally transfer to novel material, practice-induced functional plasticity remains predominantly melody-specific. We conclude that musical skill acquisition reflects complementary contributions of pre-existing neural characteristics and learning-induced plasticity, with baseline auditory representations potentially supporting successful behavioral transfer.

Purpose: Lower-limb prosthesis use involves interacting physical, psychosocial, and device-related outcomes that may not be fully captured by conventional clinical assessment. This study aimed to develop and evaluate a stakeholder-informed framework of outcome domains relevant to meaningful everyday prosthesis use. Materials and Methods: A mixed-methods participatory design comprised a structured synthesis of selected clinically relevant content from five established patient-reported outcome measures; semi-structured interviews and importance and actionability ratings with 18 contributors (12 prosthesis users, four clinicians, and two industrial partners); and integration of the synthesis, qualitative, and rating findings. Interview records were analysed using reflexive thematic analysis, and ratings were analysed descriptively. Results: The resulting framework comprised four interrelated domains: Mobility, Physical Function, Psychosocial Wellbeing, and Prosthesis Experience. Mobility showed the clearest convergence across stakeholder perspectives. Prosthesis users showed the largest importance actionability gap for Prosthesis Experience (4.5 vs 3.0), whereas clinicians showed the largest gap for Psychosocial Wellbeing (5.0 vs 3.0). Interviews highlighted day-to-day variability in prosthesis use and the influence of confidence, fatigue, comfort, environmental conditions, social context, and device usability. Conclusions: Meaningful outcome assessment in prosthetic rehabilitation should extend beyond mobility alone to consider physical function, psychosocial wellbeing, and prosthesis experience within everyday contexts. The proposed framework provides a stakeholder-informed foundation for multidimensional outcome assessment in prosthetic rehabilitation.