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The Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) is a standardized diagnostic music-based assessment that assesses awareness in adults with profound brain injury resulting in prolonged disorders of consciousness (PDOC). Assessment outcomes help to plan patient-centered treatment based on the data collected in sessions. It is validated only in English, however, is used by clinicians trained in its use in 28 countries around the world. We report on preparatory work to validate the Spanish language (MATADOC-ES) and the Brazilian-Portuguese (MATADOC-PB) MATADOC, following International Test Commission (2016) guidelines. Two expert panels of music therapy clinicians experienced in PDOC in Spanish/Brazilian cultures worked to refine forward translations of the MATADOC from both linguistic perspectives and cultural sensitivity in preparation for testing the MATADOC-ES and MATADOC-PB with clinical populations in Spain and Brazil. We report on the challenges and decisions made to meet rigor, cultural sensitivity and clinical utility.