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Research Article | DOI: https://doi.org/10.31579/2690-4861/676
1Graduate Program in Speech-Language Pathology, Department of Speech-Language Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
2Multiprofessional Preceptor Neuropsychologist, Santos Dumont Institute, Macaíba, Rio Grande do Norte, Brazil.
3Multiprofessional Preceptor Speech-Language Pathologist, Santos Dumont Institute, Macaíba, Rio Grande do Norte, Brazil.
4Department of Speech-Language Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
*Corresponding Author: Fernanda Vanessa da Costa Varela, Graduate Program in Speech-Language Pathology, Department of Speech-Language Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
Citation: Fernanda Vanessa Da Costa Varela, Sarah Camilla Ferreira De Oliveira Lima, Mirelly Danglês de Oliveira Ferreira, Dionísia Aparecida Cusin Lamônica, Cíntia Alves Salgado Azoni, (2025), Characterization of Written Language Skills in Children and Adolescents with Myelomeningocele, International Journal of Clinical Case Reports and Reviews, 25(1); DOI:10.31579/2690-4861/676
Copyright: © 2025, Fernanda Vanessa da Costa Varela. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 10 March 2025 | Accepted: 28 March 2025 | Published: 09 April 2025
Keywords: meningomyelocele; reading; educational status; learning
Myelomeningocele (MMC) is a type of open spina bifida caused by the improper closure of the neural tube during development, which can lead to motor, neurological, and cognitive impairments. Recurrent hospitalizations may negatively impact development and literacy acquisition. Understanding this population's reading and writing challenges is essential for transforming their educational practices. This study aimed to characterize the written language skills of children and adolescents with MMC. This cross-sectional, quantitative, qualitative study involved nine children and adolescents with MMC of both sexes, aged 7 to 15 years, with academic difficulties. They were assessed regarding intellectual capacity, phonological awareness, rapid automatized naming, phonological working memory, reading and writing words and nonwords, identifying graphical aspects of writing, and attitudes toward reading. The results showed that all participants performed worse in the execution than the verbal domain; six performed below expectations in phonological awareness, with the greatest deficits at the phoneme level; four had impairments in rapid automatized naming; six performed below expectations in phonological working memory, with severe deficits in reading and writing. Moreover, four participants had graphic changes consistent with signs of dysgraphia. Despite these challenges, all participants were interested in reading and writing. It is concluded that the children and adolescents in this study had difficulties in skills related to reading and writing development but were interested in and enthusiastic about reading.
Myelomeningocele (MMC) is a type of spina bifida caused by the improper closure of the neural tube during the gestational period. It is characterized by an alteration in the spinal cord located at any point along the spine, marked by the presence of a skin-covered sac with nerves, cerebrospinal fluid, and the spinal cord (Melo et al., 2018; Matson et al., 2005).
Moreover, Arnold Chiari type II malformation, hydrocephalus, motor impairments, neurogenic bladder and bowel, intellectual disabilities, and emotional, social, and psychosocial disorders may be comorbid with this condition (Fletcher et al., 2020). External ventricular drain (EVD) procedures are used to drain cerebrospinal fluid and manage hydrocephalus, a condition present in almost all cases of MMC. However, this technique may fail throughout the person's development, leading to recurrent hydrocephalus symptoms and, consequently, the need for additional drain replacement surgeries (Takoutsing et al., 2023).
Folic acid deficiency is among the various causal factors of MMC (one of the most common malformations among live newborns) and a significant risk factor for improper neural tube development. Other factors, such as the family's socioeconomic status, may also be related to the causes of MMC (Silva et al., 2018; Au et al., 2010).
MMC is classified into functional levels based on the analysis of its neurological involvement, which can be thoracic, lumbar, or sacral (Argento et al., 2011). This functional classification is linked to daily life activities and facilitates care throughout the individual's lifespan (Rethlefsen et al., 2021).
The neuropsychological phenotype of MMC may vary qualitatively, especially when associated conditions such as hydrocephalus are present. Nevertheless, it is often linked to central deficits in processing speed, attention, and movement that emerge early in development (Wasserman et al., 2016).
This population faces difficulties in word decoding and reading comprehension during their reading and writing development, which enhanced by personal factors, lead to academic challenges and a slower literacy acquisition (Pike et al., 2013; Yates, 2003). Furthermore, challenges in integrating these children into the school environment help delay their literacy process (Pike et al., 2013; Salomão et al., 1995).
In addition to health-related challenges, children and adolescents with MMC who attend school may lack accessibility in these environments (Freitas et al., 2020). They may also encounter other daily barriers, which can negatively impact their development (Pike et al., 2013; Salomão et al., 1995).
Reading and writing are essential for inclusion, social participation, access to information, and professional development. Studies on the relationship between individuals with MMC and written language are increasing (Pike et al., 2013; Lamônica et al., 2011; Rozensztrauch, Iwanska & Baglaj, 2021). Therefore, understanding the functioning of individuals with MMC regarding written language development is of utmost importance.
Considering these people’s neurological and social aspects, this study hypothesized that children and adolescents with MMC may have impaired written language performance, given the multidimensional nature of the condition. Thus, the study aimed to characterize written language skills (phonological processing, reading, and writing) and intellectual skills of children and adolescents with MMC.
This cross-sectional, quantitative, qualitative study characterized the written language skills of children and adolescents with MMC, participants of the Pediatric Spinal Cord Injury Clinic at a Brazilian Specialized Rehabilitation Center. It was approved by the Research Ethics Committee under evaluation report no. 5.132.945.
This Pediatric Spinal Cord Injury Clinic serves 27 children and adolescents undergoing physical, occupational, and speech-language-hearing therapy, nutritional, psychological, and medical treatment, and social assistance. Participants were selected based on the inclusion criteria: age (7 to 15 years), both sexes, diagnosis of MMC, with reading and writing difficulties reported by the caregivers, the participants, and/or the therapists who worked with them, and an intellectual level appropriate for their chronological age according to neuropsychological assessment. The exclusion criteria were other associated diagnoses. All participants underwent prior audiological and neuropsychological evaluations. All participants had hearing results within normal limits. In the neuropsychological evaluation, participants who did not have an average IQ were excluded. By applying these criteria, nine children and adolescents aged 7 to 15 years were selected by convenience (since they were treated at the clinic). The other participants did not meet the criteria due to inability to attend study sessions regularly, age outside the 7-15-year range, or lack of written language issues.
Table 1: Characterization of the sample.
Characterization of the sample:
All nine (100%) participants underwent surgery to correct MMC within the first 24 hours of birth. All had hydrocephalus and had a drain inserted – a fundamental procedure for relieving intracranial pressure. Moreover, all participants had drain corrections throughout their development, requiring recurrent hospitalizations, and hindering their development.
Chart 1. Number of external ventricular drain revisions per participant.
Regarding birth and development data in the first years of life, one participant (P9) was premature (35 weeks) and had jaundice, requiring 12
days in the ICU to adjust bilirubin levels. This same participant had a tethered spinal cord throughout development and underwent surgical procedures to correct the issue. Two participants (P3 and P9) experienced seizures when younger and took phenobarbital for less than 2 years after the seizures. One participant (P8) was diagnosed with Chiari Type 2 syndrome and strabismus. All participants have been enrolled in multidisciplinary therapies since the first year of life, including psychological, physical, occupational, and speech-language-hearing therapy (focused on dysphagia and oral language). Only two of the nine participants do not use a wheelchair.
The sample comprised nine participants – seven (78%) males and two (22%) females. Five (56%) attended private schools, and four (44%) attended public schools. Moreover, six (67%) participants had a lower-back injury, and three (33%) had a thoracic injury.
The participants and their families were informed about this study and signed informed assent and consent forms, respectively.
The participants’ parents/guardians initially answered a semi-structured medical history survey, providing prenatal, perinatal, and postnatal information. They reported on surgeries to correct MMC and hydrocephalus, the need for subsequent surgeries, neuropsychomotor development, and the participant's literacy process. Next, their written language was assessed. The study used the following instruments:
Neuropsychological assessment:
a) Intellectual Capacity Screening: The Wechsler Abbreviated Scale of Intelligence (WASI) is an intelligence assessment instrument applicable to individuals aged 6 to 89 years (Wechsler et al., 2014). It provides a brief and psychometrically reliable measure of intelligence (Yates et al., 2006), providing information on total intelligence quotient (TIQ), performance IQ (PIQ), and verbal IQ (VIQ) through the application of four subtests (Vocabulary, Block Design, Similarities, and Matrix Reasoning). These subtests evaluate various skills, including fluid and crystallized intelligence, verbal knowledge, visual processing, and visuospatial reasoning (Malloy-Diniz et al., 2016). As a psychological test, the WASI is exclusively for use by psychologists, as stipulated in Paragraph 1 of Article 13 of Brazilian Law no. 4.119/62. Therefore, its content cannot be included in the Annex. Accordingly, this research had the WASI administered by psychologists registered with the Regional Council of Psychology of Rio Grande do Norte, Brazil (CRP-17).
Speech-language-hearing assessment:
a) Evaluation of Phonological Awareness, using the Sequential Assessment Instrument (CONFIAS) (Moojen et al., 2003). This test assesses phonological awareness – i.e., the ability to reflect on and manipulate speech sounds comprehensively and sequentially. This allows for the investigation of phonological skills in relation to spelling hypotheses.
b) Automatized Naming Assessment using the TENA Automatized Naming Test) (Silva, Mecca, & Macedo, 2018), which estimates the person's ability to recognize a visual symbol and name it accurately and quickly.
c) Phonological Working Memory Assessment using the Nonword Repetition Test (Grivol & Hage, 2011), which assesses the memory responsible for storing information temporarily to support performance in various cognitive tasks. It consists of nonwords with low, medium, and high similarity and can be used with students starting from the 1st grade.
d) Reading and Writing Assessment using the School Performance Test (TDE II) (Stein, 1994), which objectively assesses fundamental academic performance skills, specifically in writing, arithmetic, and reading. It provides a comprehensive overview of which areas of academic learning are preserved or impaired in the examinee. This study did not include the arithmetic test.
e) Dictated Text Writing, using the Dysgraphia Scale proposed by Lorenzini (1993). Participants are provided with a sheet of paper and a no. 2 black pencil. The scale allows for a quantitative analysis of writing based on scores assigned to 10 analysis items.
f) Scale of Attitudes Toward Reading (Condemarim & Medina, 2005), consisting of a sheet with a character depicted in four poses (very happy, content, annoyed, and very bored/uneasy). The child is asked to respond to seven reading-related questions and mark with an "X" the corresponding profile.
The results of the medical history survey, intellectual capacity screening, phonological awareness assessment, rapid automatized naming, phonological working memory, reading, and writing were analyzed qualitatively and descriptively, in accordance with the expected outcomes. The Shapiro-Wilk normality test was used regarding the sample distribution, indicating a non-normal distribution of the research participants. The results are presented in tables.
All caregivers reported the participants had difficulties with reading and writing skills and the literacy process.
The study found a significant difference (p = 0.05) in the participants’ performance in VIQ (assessing expressive language, oral skills, verbal reasoning, and concept formation and summarization), PIQ (assessing non-verbal concept formation, visual perception and organization, simultaneous processing, and visuomotor coordination), and TIQ (Wechsler et al., 2014). VIQ was higher (M = 109.7; SD = 18.9) than PIQ (M = 85.9; SD = 14.1), when compared to the normative data expected for their age (Table 2).
| Participant | IQ | Verbal Classification (VIQ) | IQ | Performance Classification (PIQ) |
| P1 | 97 | Average | 63 | Much lower |
| P2 | 93 | Average | 92 | Average |
| P3 | 69 | Extremely low | 66 | Extremely low |
| P4 | 131 | Much higher | 104 | Average |
| P5 | 102 | Average | 72 | Threshold |
| P6 | 106 | Average | 75 | Threshold |
| P7 | 131 | Much higher | 97 | Average |
| P8 | 132 | Much higher | 95 | Average |
| P9 | 129 | Superior | 103 | Average |
Caption: IQ = intelligence quotient
Table 2: Classification of the verbal and performance domains (Condemarim & Medina, 2005).
Moreover, they performed significantly lower in PIQ than the normative average (t = -3.59, p = .005). No significant differences were found in TIQ between the participants (M = 96.9 σ = 17.4).
Regarding the reading predictors involving phonological processing, three participants (P2, P4, and P7) performed as expected in phonological
awareness at both the syllable and phoneme levels according to the alphabetic spelling hypothesis, while the others (n = 6, P1, P3, P5, P6, P8, and P9) had results consistent with the syllabic-alphabetic spelling hypothesis. These results align with these children’s writing level in the written assessment. All participants had greater difficulty in the phoneme level than in the syllable level (Table 3).
| Participant | Syllabic level | Spelling hypothesis | Phoneme level | Spelling hypothesis | Total performance |
| P1 | 33 | Syllabic-Alphabetic | 12 | Syllabic-Alphabetic | 45 |
| P2 | 40 | Alphabetic | 24 | Alphabetic | 64 |
| P3 | 26 | Syllabic-Alphabetic | 17 | Syllabic-Alphabetic | 43 |
| P4 | 39 | Alphabetic | 26 | Alphabetic | 65 |
| P5 | 31 | Syllabic-Alphabetic | 14 | Syllabic-Alphabetic | 45 |
| P6 | 26 | Syllabic-Alphabetic | 17 | Syllabic-Alphabetic | 51 |
| P7 | 37 | Alphabetic | 29 | Alphabetic | 66 |
| P8 | 35 | Alphabetic | 12 | Syllabic-Alphabetic | 47 |
| P9 | 25 | Syllabic-Alphabetic | 17 | Syllabic-Alphabetic | 42 |
Caption: All participants were expected to be in the alphabetic spelling hypothesis.
Table 3: Participants' performance in the phonological awareness assessment according to the spelling hypothesis (Ferreiro & Teberosky, 1991).
Moreover, only three children performed according to the reference standards in automatized naming (Silva, Mecca, & Macedo, 2018). The percentiles and results show that P7’s and P8’s results were average in colors, letters, and objects and below average in digits. P9’s performance was below average in colors, letters, and digits and inferior in objects. The other participants (n = 6) did not have their values compared to their ages, as the reference standards provided comparative data for children aged 3 years to 9 years and 11 months (Silva, Mecca, & Macedo, 2018). Thus, a qualitative analysis comparing the group's performance with the instrument’s maximum reference showed that only P2 and P4 had results above average in all stimuli, whereas the others (n = 4) had inferior results in letters and digits and average, below average, and inferior results in the other fields (Table 4).
| Part | C (s) | Perf | Perc | L (s) | Perf | Perc | D (s) | Perf | Perc | O (s) | Perf | Perc |
| P1* | 51 | A | 50 | 47 | I | 10 | 49 | I | 10 | 52 | BA | 25 |
| P2* | 33 | AA | 90 | 18 | AA | 90 | 18 | AA | 90 | 35 | AA | 90 |
| P3* | 69 | I | 10 | 43 | I | 10 | 51 | I | 10 | 45 | A | 50 |
| P4* | 38 | AA | 90 | 20 | AA | 90 | 23 | AA | 90 | 36 | AA | 90 |
| P5* | 58 | BA | 25 | 42 | I | 10 | 54 | I | 10 | 65 | I | 10 |
| P6* | 50 | A | 50 | 33 | BA | 25 | 32 | A | 50 | 49 | A | 50 |
| P7 | 46 | A | 50 | 30 | A | 50 | 39 | BA | 25 | 46 | A | 50 |
| P8 | 56 | A | 50 | 40 | A | 50 | 53 | BA | 25 | 45 | A | 75 |
| P9 | 60 | BA | 25 | 44 | BA | 25 | 53 | BA | 25 | 77 | I | 10 |
Caption: Part = participant; C = color; Perf = performance; Perc = percentile; L = letters; D = digits; O = objects; s = time in seconds; A = average; I = inferior; AA = above average; BA = below average; * = patients whose ages were above the protocol’s reference standards.
Table 4: Participants' automatized naming performance (Silva, Mecca, and Macedo, 2018).
Only two children performed according to the reference standards in phonological working memory (Grivol & Hage, 2011). P8 performed as expected only in nonword repetition, while P9 achieved the expected value only in backward digit repetition. All other participants (n = 7) completed the activities in full. The comparison of their results (they were above 9 years old) with the test’s reference standards (8 years and 11 months) showed that all scored more than 69 points in nonword repetition, but only P2 reached the reference value in forward and backward digit repetition. The others (n = 6) had results below expectations in different parts of the protocol – nonword, forward, or backward digit repetition (Table 5).
| P | CR | ECR | T (s) | ET (s) | CW | ECW | T (s) | TE (s) |
| P1* | 5 | 30 | I | 60 | 0 | 21 | I | 336 |
| P2 | 32 | 30 | 52 | 60 | 12 | 21 | 302 | 336 |
| P3 | 5 | 29 | I | 77 | 1 | 14 | I | 355 |
| P4 | 29 | 28 | 82 | 89 | 12 | 12 | 389 | 424 |
| P5 | 27 | 28 | 87 | 89 | 4 | 12 | I | 424 |
| P6 | 23 | 28 | 96 | 89 | 0 | 12 | 526 | 424 |
| P7 | 32 | 28 | 91 | 97 | 19 | 8 | 336 | 410 |
| P8 | 27 | 23 | 142 | 155 | 10 | 14 | 535 | 506 |
| P9 | 26 | 23 | 153 | 155 | 7 | 14 | I | 506 |
Caption: P = Participant; CR = correct reading; ECR = expected correct reading; T = time; s = time in seconds; ET = expected time; CW = correct writing; ECW = expected correct writing; I = interrupted; * = participant whose age was above that of the test
Table 5: Participants’ performance in phonological working memory (Grivol & Hage, 2011).
Regarding reading, the quantitative TDE II analysis showed that P2, P4, P7, P8, and P9 performed as expected for their education level. The others (n = 4) did not reach the minimum expected performance. Moreover, P1, P3, and P6 were unable to read the words within the expected time, and P1 and P3 had to stop the assessment due to difficulties with decoding (Table 6).
| Participant | Reading Classification | Writing Classification |
| P1* | SD | SD |
| P2 | RD | WE |
| P3 | SD | SD |
| P4 | MMD | MMD |
| P5 | SD | SD |
| P6 | SD | SD |
| P7 | AE | AE |
| P8 | SD | SD |
| P9 | SD | SD |
Caption: SD = severe deficit; RD = risk for deficit; WE = within the expected; MMD = mild to moderate deficit; AE = above the expected; * = participant whose education level was above the test’s reference standard.
Table 6: Results obtained in and expected for the TDE II reading and writing subtests (Stein, 1994).
Regarding the writing assessment, P4 and P7 achieved the expected number of correct answers for their education level, with 12 and 19 correct answers, respectively. P2, P4, and P7 completed the subtest within the expected time, whereas four participants (P1, P3, P5, and P9) requested to stop the assessment due to difficulties in word encoding, making it impossible to analyze their testing time. P1's results were compared to those of 9th-graders because their education level was above the one indicated in the protocol (Table 6).
The protocol also interprets the results based on the children’s percentiles and their school types (whether public or private). Only one child (P7) performed above expectations in both reading and writing, whereas P2 performed as expected in reading, and P4 had a mild to moderate deficit. The others (n = 6) had severe deficits in both skills, according to their school types (public or private – Table 7).
| Participant | Reading Classification | Writing Classification |
| P1* | SD | SD |
| P2 | RD | WE |
| P3 | SD | SD |
| P4 | MMD | MMD |
| P5 | SD | SD |
| P6 | SD | SD |
| P7 | AE | AE |
| P8 | SD | SD |
| P9 | SD | SD |
Caption: SD = severe deficit; RD = risk for deficit; WE = within the expected; MMD = mild to moderate deficit; AE = above the expected; * = participant whose education level was above the test’s reference standard.
Table 7: Test interpretation based on percentiles and school types (Stein, 1994).
The text dictation analysis (Lorenzini, 1993) showed that P1, P3, P5, and P9 performed consistently with signs of dysgraphia, as they scored above 8.5 (cursive handwriting) and 6 points (print handwriting). The other participants (n = 5) had inferior results and were not classified with dysgraphia (Table 8).
Caption: P = participants; WL = wavering lines; A/DL = ascending/descending lines / ISBW = irregular space between words; RL = rewritten letters; AAC = arch angle curvature; JP = junction point; CA = collisions and adherences; AM = abrupt movements, ID = irregular dimensions; PS = poor shapes; C= classification; LT = letter type
Table 8: Dysgraphia scale results (Lorenzini, 1993).
Although all study participants had intellectual capacity appropriate for their chronological age, the study showed that 67% had difficulties in phonological processing, reading, and writing skills, and had worse results in PIQ than VIQ.
Conditions comorbid with MMC may lead to complications that could interfere with these people’s development, integration into different social environments, psychological-linguistic processes, and learning. The presence of hydrocephalus associated with MMC, the need for surgical drain corrections, and other issues may result in a heterogeneous and complex condition, causing additional impairments that interfere with language development and learning (Mont-Serrat, 2018).
The need for recurrent surgeries and frequent hospitalizations may have influenced the educational process of the children and adolescents in this study, as they interrupt educational activities. This poses another risk factor for literacy delays because they need to be absent from school activities, ultimately slowing them from achieving the expected performance for their age groups and education levels (Cunha, Silva, & Palladino, 2014; Façanha, 2015).
Although the study participants’ intellectual capacity was clearly adequate, the impact on PIQ in MMC’s neuropsychological profile can be explained by this population’s motor difficulties. The latter affect the writing process over their development but do not directly impact their other cognitive skills to acquire reading and writing, especially when considering factors within a broader context (Silva, 2019). Thus, education and health professionals should understand how to assign writing tasks in the classroom or other settings, as these children and adolescents’ time and execution may not be the same as those with typical development.
It is known that phonological processing is essential for proper reading and writing performance (Schoenel et al., 2020). The 67% of children in this study who had phonological awareness difficulties and performed below expectations for their education level (Capovilla & Capovilla, 1998) are still at the syllabic-alphabetic writing stage, although they should already be at the alphabetic stage, according to the spelling hypotheses (Ferreiro & Teberosky, 1991). It is inferred that these children’s literacy difficulties are similar to those of children with learning disorders, who likewise have deficits in phonological awareness and reading and writing performance, although they are different health conditions (Silva & Godoy, 2020; Leite, Alpes, & Mandrá, 2022). Therefore, understanding linguistic and metalinguistic functioning is essential for designing an appropriate intervention regardless of the underlying diagnosis.
The difficulties of the children and adolescents in this study regarding the phoneme level were more pronounced than those at the syllable level, in line with the developmental hypothesis of the hierarchy of learning acquisition. This is because syllables require less analytical thinking than phonemes (Pestun, 2004; Lisboa & Jesus, 2019).
The ability to access the lexicon and process information is also essential for reading and writing development. Rapid automatized naming can provide insights into the speed of lexical access and predict reading speed (Georgiou & Parrila, 2020). Among the 34% of children whose results were compared with the test's reference values, two (P8 and P9) performed below expectations on the overall test, indicating a significant relationship with potential reading difficulties (Georgiou & Parrila, 2020). This is consistent with their below-expected performance in the reading and writing assessments.
Phonological working memory plays a crucial role in the development of written language, as reading requires children to decode letters and convert them into sounds while rapidly memorizing this sequence (Grivol & Hage, 2011). In this sample, the two children whose performances were compared to the test's reference standards showed impairments in repetition skills, whether in nonword or digit repetition. Among the others, a qualitative analysis revealed that 45
Assessment findings and result characterization identified difficulties in phonological processing skills, word and pseudoword reading, writing, spelling, and the PIQ in children and adolescents with MMC. Despite these challenges, the participants were enthusiastic about and interested in reading, which may predict progress and facilitate the written language intervention.
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"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Giselle Pentón-Rol.
