Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project “VOICE”—vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent.

This study aimed to conduct a systematic review of the applications of the Singing Voice Handicap Index (SVHI) in different clinical and scientific contexts. A systematic search was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines, covering articles published between 2018 and June 2024 in the Cochrane, ScienceDirect, Web of Science, Scopus, and SciELO Brasil databases. Eligibility criteria included clinical trials and observational and statistical studies. Articles in Brazilian and European Portuguese, as well as English, were considered. Study selection was performed by three researchers: two independently conducted the initial screening, while the third resolved conflicts and made final decisions. The risk of bias and reliability of the evidence were assessed using the RoB 2.0 and GRADE tools to ensure the inclusion of methodologically robust studies. A total of 111 studies were gathered, and after all phases of selection, 26 were included. The findings revealed a wide range of SVHI applications in various clinical interventions, highlighting its adaptability to different methodological approaches. The evidence analysis showed that 92.31% of the studies had a low risk of bias, reinforcing the reliability of the evidence included in the review. The diverse applicability of the SVHI as a vocal assessment instrument highlights its flexibility and adaptability across different study types and interventions. Moreover, this protocol has proven effective in standardizing and comparing results. This study reinforces the SVHI as an essential tool in both clinical and academic settings.

This study examined the immediate effects of the Finger Kazoo (FK) exercise, with and without intentional oropharyngeal enlargement, on acoustic, self-perceptual, and auditory-perceptual parameters of the operatic singing voice. Fifteen classically trained singers screened using the Singing Voice Handicap Index-10 performed two randomized conditions: FK without oropharyngeal enlargement (Condition A) and FK with oropharyngeal enlargement (Condition B). Assessments included: (1) self-perception using the Evaluation Auditory-Perceptual Instrument for Operatic Singing Voice-EAI Scale; (2) acoustic analysis of maximum phonation time (MPT) for vowels /a/ and /i/, examining fundamental frequency (F₀), jitter, and shimmer; and (3) blinded auditory-perceptual ratings of aria excerpts by a 15-member expert panel. Statistical procedures comprised paired and nonparametric tests (t, Wilcoxon, and Friedman), robust analyses, and Bayes factors, with Holm-adjusted P values and effect sizes (Cohen's d, r). Both interventions significantly improved MPT and reduced jitter and shimmer (all p <.05), with very large effect sizes (Cohen's d > 0.8). Mean MPT increased by 12-15%, jitter decreased by 13-16%, and shimmer by 18-20%. F₀ remained stable across vowels and conditions (P > 0.59), indicating enhanced phonatory control without pitch alteration. Self-perception scores increased from baseline (38.5 ± 6.3) to post intervention (51.6 ± 13.6 in A; 53.9 ± 8.4 in B; P < 0.001). Auditory-perceptual ratings confirmed significant improvements across all eight EAI parameters-most notably Resonance Balance, Ring, Vibrato, and Pitch Accuracy-while Strain showed smaller but consistent reductions. No statistically detectable differences were found between Conditions A and B, with Bayesian analyses supporting equivalence (BF₁₀ < 1/3). The FK exercise produced immediate, robust, and clinically meaningful improvements in resonance, stability, and efficiency of the operatic singing voice. Both versions-performed with and without oropharyngeal enlargement-were comparably effective, underscoring the versatility of this semioccluded vocal tract technique as an evidence-based tool for singers, pedagogues, and clinicians.

This scoping review aimed to map and characterize the available evidence on neural adaptations associated with singing expertise, with a focus on experience-dependent neuroplasticity underlying vocal motor control. This scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and registered in the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/VZBQY). Eligibility criteria were defined using a Population-Concept-Context (PCC) framework. A comprehensive search was performed in PubMed, Web of Science, ScienceDirect, Scopus, and the Cochrane Library for studies published in English between 2005 and 2025. Two reviewers independently screened studies, with disagreements resolved by a third reviewer. Data were extracted and synthesized descriptively to map patterns across heterogeneous methodologies. Consistent with scoping review methodology, no formal risk-of-bias assessment was performed. Thirty-eight studies were included. Evidence consistently indicates that singing expertise is associated with enhanced auditory-motor integration, reduced reliance on external auditory feedback, and greater stability of vocal output under sensory perturbation. Findings further suggest experience-dependent functional and structural adaptations across distributed cortical and subcortical networks, including auditory, motor, somatosensory, insular, and subcortical systems. Substantial variability was observed in study design, task paradigms, and outcome measures. Singing expertise is supported by distributed, experience-dependent neuroplastic adaptations that promote efficient and predictive vocal motor control. This scoping review maps the current evidence base, emphasizes its methodological heterogeneity, and identifies key directions for future research, particularly regarding causal mechanisms, longitudinal plasticity, and task-specific adaptations.