Training to Reduce the Risk of Falling, Training in Water

Review Article | DOI: https://doi.org/10.31579/2639-4162/382

Training to Reduce the Risk of Falling, Training in Water

  • Jan Van de Rakt 1*
  • Steve McCarthy-Grunwald 2

1Physical Therapist NDT teacher IBITA, Course Leader and teacher on the Dutch Institute for Allied Health Sciences. Nursing Home “Waelwick” in Ewijk the Netherlands.

2MSc BSc RMN Lecturer in Mental Health Nursing with Dementia Specialty. University of Cumbria, Bowerham Road, Lancaster, LA1 3JD England.

*Corresponding Author: Jan Van de Rakt, Physical Therapist NDT teacher IBITA, Course Leader and teacher on the Dutch Institute for Allied Health Sciences. Nursing Home “Waelwick” in Ewijk the Netherlands.

Citation: Jan Van de Rakt, Steve McCarthy-Grunwald, (2026), Training to Reduce the Risk of Falling, Training in Water, J. General Medicine and Clinical Practice, 9(11); DOI:10.31579/2639-4162/382

Copyright: © 2026, Jan Van de Rakt. 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: 17 October 2026 | Accepted: 03 November 2026 | Published: 10 November 2026

Keywords: hydrotherapy; balance issues; pathological tone; training rules

Abstract

Background/ Aim 

Training to improve balance in people who have already given up a lot of that control and therefore gain nothing from a “prevention” program. Especially the “effort” that the remaining system has to exert against gravity often triggers pathological tone that suppresses selectivity. 

Design.

Mapping out the problem, understanding why this group falls so frequently, and creating an environment that is both safe and significantly reduces the effects of gravity.

Result

The water environment creates what this group needs to be able to move at their level and from there train. In order to make a transfer to land, this training must meet the training rules, and these are often quite frequently violated, resulting in an inadequate transfer of what practiced to land. 

Discussion and conclusion.

To train balance in a group that already has limited ability, occasional movement is never enough. It first requires the ability to move and a training framework focused on improving coordination and power. For this group, this can be achieved in water with a minimum training frequency of twice a week. 

Introduction

Why such a “cautious” title?

Simply because the term “fall prevention” gives the illusion that falls and thus their negative consequences can be prevented. Of course, training will help to delay and/or temporarily prevent serious consequences, but sooner or later the system will no longer be capable of this. That does not mean that training may not still be useful, but no longer with the hoped-for result. Well-known research conducted in nursing homes/long-stay facilities shows that many falls are actually caused because people no longer distribute their weight optimally and therefore unable to recover from a loss of balance in time, and of course there is always something that can be improved in the environment. [1 -6]

A good example is the study by Van Schooten et al. into the higher frequency of falls in a ward where the chairs could be a contributing factor to the increase in frequency. [7] Or the study that looked at where on the ward falls occurred most frequently. Possible causes could be limited ability to walk due to crowding and/or a lack of sufficient support points such as handrails in those areas, particularly near doors. [8] Here, training will always have to be accompanied by scanning the hazards of the environment, and the training will obviously never be able to include fall exercises unless the environment is safe enough to do so without danger. This would involve the use of harnesses or practicing in water. Training people who are at risk of falling, especially in a nursing home or long-term care facility, has its limitations, particularly because most residents often suffer from a neurological degenerative disease and their balance control is already very fragile due to pathological muscle tone. This is an additional reason to prioritize training in water, because that is where the influence of gravity is lowest and therefore the need for high muscle tone is much less, and water will eliminate the risk of falling.

Analysis of why this group has difficulty maintaining optimal balance while moving around in their environment.

By analysing video recordings [1], researchers at Frazer University in Canada came to the following conclusions as to why balance control was inadequate. We must now take a close look at the target group, because it is precisely the group living in a protected environment that often has a neurological disease (Parkinson's, MS, stroke, etc., but also dementia) and, due to pathological tone, already lacks elements necessary for optimal balance control, namely selectivity and speed. With this in mind, we must therefore examine this analysis and also look at the results. This will also limit the treatment options if pathological tone is the cause, because in addition to a suboptimal response, it also involves impaired perception. Pathological tone and impaired perception [9 - 13] go hand in hand, which could explain weight displacement as a reason for losing balance and falling. Pathological tone can be measured, but unfortunately this is often done in a lying or sitting position, and it would be very important to do so in a standing position, because then something is already being asked of the patient to maintain balance, and this can be done passively by flexing/extending the elbow at the Asworth tempo [14,15,16,17]. 

Falls in long-stay facilities. Fall prevention programs?

It is clear that the group studied by Robinovitch and his colleagues will not benefit from this, simply because their balance system is no longer capable of doing so. It would therefore be very useful to carefully assess people's capabilities in advance to prevent them from being enrolled in “fall prevention programs” that they are actually unable to participate in. Unfortunately, pathological muscle tone is often one of the causes.

Nevertheless, it is possible to offer these people therapy, but this must be done in an environment where the tone is reduced. There must therefore be a clear distinction between people who can benefit from fall prevention therapy after an incidental fall [18] and those who need to monitor their balance with additional aids. Of course, there will always be people who fall somewhere in between, but both groups will benefit from the water-based program.

Research into the causes of falls. [1- 4]

CauseNumber%
Incorrect weight transfer 9341.0
Tripping4821.1
Impact2511.0
Loss of support2511.0
Collapse2410.6
Slipping62.6
Unclear62.6

Table 1: (2012) Most common cause of falls in long-stay facilities.

This table shows that the most common reason is not the one we often find in fall reports. This can also be explained by the fact that most fall incidents are not witnessed and people try to investigate the reason/cause afterwards. Only after studying the video recordings of fall incidents in long-stay facilities.

But it was still a surprise that so many incidents were related to incorrect weight shifts. Incorrect weight shifts mean that the weight is not correctly 

distributed on one leg, preventing the other leg from moving optimally, which can occur when standing up, standing, walking, etc. The reason for this may lie in the perception from the feet, resulting in incorrect translation in the brain and a suboptimal response. The analyses carried out by the group from Frazer University confirm this picture and also provide other data. 

Cause%
Incorrect weight transfer49.5
Loss of support22.0
Tripping12,5
Impact8,8
Collapse6,7
Slipping0,5

Table 2: (2024) Most common cause of falls in long-stay facilities.

Clearly a different result, but incorrect weight transfer continues to score highly.

So any problem where too much weight remains on the two feet, but also on the arms when standing up/sitting down, can lead to a situation where it is no longer possible to restore balance.  Also look at the percentage of loss of support, because that is precisely what these people need in many places in order to create an extra point of support in time when their balance fails. This study yielded more remarkable results, showing that pathological tone has a greater influence than is often thought, particularly in this group, and that therefore requires tailored treatment.

Direction%
Achteruit lopen Backward walking (met en zonder rollator)33,8
Sidewards walking 28,8
Straigth down19,2
Forward walking 18,2

Table 3:( 2024) Direction of the fall in the long stay Facilities.

Walking backwards is precisely what causes the big fall, and often after two or three steps, things go wrong. People are unable to keep their torso in front of their “toes” and are no longer able to shift their weight from one foot to the other.[19].

Activity%
Walking33,6
Standing 24,0
Stand to sit transfer down17,5
Sitting 14,2
Sit to stand transfer 10,7

Table 4: (2024) Activity at the time of the fall.  (long stay facilities)

Sitting down is more likely to go wrong than standing up. One of the most striking findings was that in long-stay facilities, the people who fell frequently were in the group that stood up and sat down, so the emphasis here should be on furniture such as the height of the chair and the support on the side and front, etc.

What is very noticeable in long-stay facilities may not be so clear in the situations that precede them. However, it appears that people with neurological disorders have much more balance problems than their peers, including those with dementia. [20,21] 

Analyse of an attitude that can lead to an greater fall danger and especially backward falling.

Photos 1, 2, and 3: Three people who participated in a well-known “fall prevention program” in the countryside after a balance test indicated that they did not score optimally. The men in particular “failed” and were strongly advised to participate.

It was striking that the two men gave up fairly quickly because they were unable to cope with the program and that the supervisors needed extra people to prevent these two accidents. Therefore, an analysis in addition to the balance test and a check according to the guidelines is very important in order to identify individuals who will not benefit from “fall prevention training” and who would benefit more from a customized program and an environment that reduces pathological muscle tone. The red plumb line from the ear should put everyone on the right track in terms of what affects balance (weight transfer problem).

Photo 1: Weight transfer while walking appears to be fine at this point, but what is striking is the rigid upper torso, bent elbows, and stiff cervical spine. A simple test [22] revealed so many problems that he either clearly had difficulty maintaining this walking pattern or that the steps were not completed, but also that he often had difficulty stopping. A standing tone test revealed increased tension in the elbow, both in the flexors and extensors, and indicated a form of paratonia [23]. This gentleman will therefore be at the limit of his abilities in the group training “fall prevention” program, and the risk of accidents is too great, so the conclusion must be a separate program with a tone-reducing environment.

Photo 2 This gentleman needs to move as far back as possible, but it is clear that the tone of his muscles has been affected by a neurological disorder. The movement stops while the (red) plumb line is still in front of his feet. He therefore feels that he has lost control when moving further back, yet we do not see the “braking strategy” in the feet/hips/torso that we do see in photo 3. This is because the greatest muscular activity takes place at the back, the extensors of the torso all the way up to the head are active and inhibit the torso/hip muscles at the front. [24,25] If he continues, his feet will have to do the work because his torso/hips remain in the same position, which will lead to incorrect and insufficient weight transfer and result in a fall.

Photo 3 is doing well and was able to perform the balance test almost flawlessly and will be able to train perfectly in a “fall prevention training” program. Comparison also immediately gives an idea of what pathological tone does to our selectivity and what stiffness we see.

As an example, look at the tension in the arms in photos 1 and 2 compared to photo 3, hence the test of tension in a standing position with a gentle passive movement in the elbow [26] according to Asworth or a little faster according to Tardieu [14,27].  In order to train this group in a somewhat targeted manner, we must ensure that the need for this pathological tone decreases while at the same time allowing for safer, more selective movement. Each training session requires a thorough examination to determine whether other factors are affecting the balance and also need to be treated in order to optimize the results of targeted training.     

Complete examination according to the guidelines

The guidelines list a number of items that really need to be reviewed, because this will allow the training program to be much more effective. Many people have been working on adaptation for years before any problems arise, using various elements that are directly or indirectly related to the balance problem. [28,29,30].

1. Eyes /ears:

The scanning ability of the eyes to the environment is important for building alertness, but in older adults, we often see that this scanning ability is used primarily to observe where the feet should be placed, which means that objects further away are not seen. This is therefore an adjustment to another issue, namely that the sensation and perception in the feet are not optimal. 

2. Dizziness.

Dizziness presents an additional problem, as it causes the vestibular system to provide incorrect information, requiring the brain to perform extra work to recalibrate the body in space, whereas the process should ideally occur the other around.

3. Mobility and Balance sec. At the end of this list.

4. Incontinence.

The tension and increased attention cause risks to be taken more quickly, and also the phenomenon that the pressure on the sphincter muscles rises rapidly compared to a lying position.

5. Medication.

It is clear that careful consideration must be given to their effects, as low blood pressure can cause dizziness, but also delay reactions or even reduce muscle tension. [31].

6. Home and environment factors. [32]

These factors often indicate that balance checking has become more difficult and that an update of the home and environment is necessary, and the aids are already is use.

7. Pain. [33]

The impact of pain on movement is significant and can therefore hinder balance recovery.

8. Inflammations.[34]

Inflammation also has a negative effect on our balance ability.

9. Tone, especially pathological tone. [35,36]

We see pathological tone in neurological disorders, and measuring this tone is therefore essential to know what influence it has, especially on movement speed. Particularly in balance recovery, speed is an essential element and can thus be decisive. The measurement is performed passively and often in an “rest”-position, and then it appears that this increase in not so necessary. The difference between measurement in the sitting or standing position of the elbow was significant higher. [37] Higher tonus in elbow is a sign of higher tonus in the entire back of the torso and one of the reasons why walking backward often can end in a fall. 

Ad.3. Mobility and Balance sec. [38,39]

This is the central system capable of detecting and responding well within time.

The detection involves weight shift and approaching limits, and the reaction of muscles patterns creates a counter-movement to correct it. All other systems require more time and are therefore actually used to detect danger and make correction unnecessary and/or to keep the system extra alert. This system monitors the borers and intervenes, but at the same time, the system is at its sharpest when things “almost” go wrong at the border and everything must be brought out to restore balance on the spot or with an excursion- step. 

The last two elements:

1. Tone (tone, and in particular pathological excessive tone, often in combination with pathological synergy) and

2. Mobility and balance can be treated through training. This does not mean that the loss is reversible, but that muscle capacity in particular can be improved. Muscle recovery and plasticity [40,41] of muscle tissue is unprecedented, but this requires the ability to move and, if possible, to move against resistance, causing muscle fatigue, which stimulates greater coordination and an increase in muscle patterns. [42].

The population studied here by means of video recordings needs less “stress” on the “feet” so that weight transfer can be practiced more effectively.

Furthermore, it is essential for this group to practice task-specific exercises so that the transfer of what has been trained is optimal. [43,44,45].

The element: pathological tone, pathological synergies, which make movement stereotypical and very “poor,” requires a decrease in gravity because this increase is necessary if the damaged brain wants to keep the body moving. When that “load” is removed, we see that the tone decreases, but that more selectivity often becomes possible and can therefore be trained. [46] Exercising in water will produce this effect and also stimulate the input system [47,48,49,50], which can lead to increased capacity, initially in the water but certainly also on land.

However, anyone who trains coordination and muscle patterns/power must adhere to the training rules. [46,47] 

1.Determination of 1 RM (Repetition Maximum) for the movement we want to train. For example, holding back the pressure at the front until it becomes so high that it is no longer possible. Just before that, you have 1 RM of the muscle patterns that prevent you from being pushed backward and that you use when breaking a weight movement backward.                                                                                                                   

The reaction in the feet and torso/hips must also be observed and tested, dorsal flexion in the ankles and flexion in the torso/hips. We now know what coordination/power is present and we also know whether there is pathological tone, and it is important to test this again after 10-20 minutes in chest-high water and adjust if necessary.

2.After the assessment, we can put together a program in which this movement can be specifically trained with a 1 RM of 75% and 3 sets of 10 repetitions, less resistance than more repetitions, twice a week with a minimum frequency of twice a week. This means that training in the water once a week does not meet the training rules, and it will therefore be very difficult to expect an effect both in water and on land with less training. [51] In studies where the frequency of at least twice a week was achieved, it was clear that the effect was also present on land. And we are not referring to all those additional effects on mental well-being, sleep, etc. [52].

3.Task-specific training requires a number of elements to be present in order to achieve this effect.

  1. A task-specific exercise requires equality in the internal movement structure, i.e., the muscle patterns required for that movement, in order to perform the movement optimally. 
  2. What applies to muscle patterns also applies to the external movement structure, which must also match the movement we want to train. Of course, you can also train both the internal and external aspects in parts, but try to stay as close to the task as possible. 
  3. The energy required for that task must be at least the same, but actually more, so that “fatigue” occurs.
  4. The sensory input must be consistent with the task. This means that the brain receives input that directly matches the task. 
  5. The intention of the movement must be related to that task, in contrast to the intention often found in isolated strength training. The intention is to perform the task better/faster. 

Training this group therefore often requires tone reduction, which can really only be achieved in water. Combined with the training rules, even this group could still achieve reasonable results. Group therapy is often not feasible; it is best done individually or with a maximum of two patients per therapist, and the exercises must be adapted. However, what often happens—a little walking and playing games/doing assignments without paying specific attention to the task and/or training rules—is not exercise aimed at optimizing the coordination and power of muscle patterns. Often, the main program focuses solely on walking, dual tasks, and balance training, but muscle pattern training is lacking, as is movement in other positions such as lying down and/or sitting; even standing up from a sitting position is rare.

Nevertheless, there are even results to report, especially in patients with dementia [53,54], who are actually encouraged to move by the water and also because the need for muscle tone is less in water and movement is also possible. This in turn stimulates the cardiopulmonary system, which has positive effects due to the improved blood circulation in the brain. The element that water offers is therefore movement with less need for extremely high muscle tone and, with sufficient repetition and frequency, this will also be noticeable in movement on land, especially for people with neurological disorders. [55,56]

Practice:

This group often already moves with an aid, so the first goal is to see if they can move without help/aids and, if not, to focus the training on that. This means getting into the water with a wheelchair, standing up, and walking along the edge of the pool, with assistance if necessary. In the meantime, work on water adjustment [57], so that people get used to the water again and dare to go under, and always make use of this if people want to swim.

Be especially careful at the beginning, because many people haven't swum for a long time and when they get into the water, they often take risks too quickly by going “too deep” or bending their knees, which also causes you to go “deep” into the water and maximizes the upward pressure. And then different rules apply to movement, especially because the information under the feet also changes due to the loss of support.

The best example is that when you are standing in water up to your neck, moving your head forward (looking at your feet) will cause your feet/legs to “push” backward and upward, and to reverse this, the movement can be reversed by moving your head and upper torso backward.

In other words, water at that level requires control from the upper torso, around Thoracic 11 both above and below (feet/legs), and below it most resembles the movement control on land but with less force and muscle tension. Training in water naturally has a “learning effect,” but this happens “automatically” because it involves adapting to the environment, which anyone can do. So let people experience it and don't interfere too much, but provide simple assistance to ensure that everything goes well. And with sufficient frequency, there will also be a transfer, first to a lower water level and then to land. [58,59] Start by walking along the edge, or under supervision and/or with flotation devices, and build on this. From the start, make sure that walking backwards and sideways is included. Walking backwards [19] is particularly important for this group! 

Photo 4: Walking training with extra flotation devices. Walking backwards is an activity that this group definitely needs, but is often difficult due to the “rigidity” of the back, which is necessary for them to maintain their balance. When walking backwards, this tension must be reduced, and more flexion in the torso/hips gives much more control over walking backwards. By eliminating gravity, the need for that higher back/hip tension becomes less necessary, allowing for more selectivity and making it possible to walk backwards again. Again, we can turn this into task-specific resistance training with the right repetitions and frequency, but backward walking can also be practiced with less resistance and more repetitions, or with no resistance at all and at increasingly higher speeds.

In this patient group, movements include lying down and sitting up from a lying position. These movements often require assistance from others or devices and are rarely or never trained. 

Training refers to a task-specific resistance program with sufficient repetition and frequency, resulting in muscle pattern fatigue that stimulates the system to function optimally. 

Rotating around the axis, which is often not possible on land, turns out to be possible in water, and now this can also be trained, making it easier on land as well. Moving from lying down to sitting and maintaining balance while sitting can be trained perfectly in water. What seems too difficult on land turns out to be possible due to the reduction in gravity. 

Photos 5, 6, and 7: Training trunk movement in lying position and from lying to sitting and back. Task-specific training, resistance possible, and training rules can be applied. Provided that the frequency of training is at least twice a week.

Be aware that the maximum effect that can be achieved is that the ability to move in bed, from sitting on the edge to standing up, improves through training in the water, but this requires training according to the training rules, otherwise that transfer will not take place.

Picture 1: Stand-up training with an unprecedented amount of variation, simply by adjusting the water level. Picture 1 shows a level at approximately Th 11, which requires a great deal of concentration to perform the movement perfectly and maintain balance with a falling waterline and therefore more load. And when people enter the water with a wheelchair, it immediately becomes a movement—standing up—that is very difficult on land but is now suddenly possible due to the water level.

From that starting point: standing up from a wheelchair in the water, a movement that is now possible again, we can determine the 1 RM for standing up and draw up a training schedule.

Picture 2: Stand up with a plank in your hands and to determine a form of 1.R.M., it is important to look at how it is performed and how often in succession.   Ask for a slow movement and then you can assess how heavy it is, especially by repeating it a few times. Often, after just a few times, you will see that it leads to muscle pattern fatigue and you are close to 1 R.M. However, you could also do the calculation using 10 R.M. to determine what load should be performed how often and for how long.

Pictures 3 and 4: From a sitting position on the table, a training program can be developed to further train lying down and sitting. This improves transfers to and from bed, but also teaches how to prevent falling backwards in water.

This element—falling backward—is a common cause of falls in this group, even when walking with a walker [19]. It appears that the ability to reduce tension in the spine and hips is no longer functioning optimally. People with degenerative neurological disorders in particular need this high tone to be able to walk, especially forward, but when they walk backward or turn with or without an assistive device, maintaining balance appears to be very problematic. Exercising in water at least twice a week can have a positive effect, and this also includes practicing movements in and out of bed. Don't underestimate the effect of practicing in a lying/sitting position and all the variations in between, and their transfer to movement in and out of bed. In the pool with a lift, buoyancy is quickly used, and you can practice moving to a sitting position and even standing position and back again.

Photos 8 and 9: A person on land sitting in a wheelchair, still able to walk with assistance and a walker under supervision. Movements such as getting up and turning in bed, and getting up from a sitting position, were almost always dependent on assistance. Training in water makes these movements easier, and we immediately have an opportunity to train the muscle patterns specifically for specific tasks and try to improve the level.

Sitting on the table and moving to stand up or lie down is a training similar to bedtime exercises, while simultaneously practicing the release of high tension in the posterior spine. This stiffness is often caused by gravity and will therefore decrease in water, often revealing selectivity and the ability to flex the torso and hips.

Photo 8 shows the start of a relaxing movement in water [61,62] – Watsu – to achieve this effect and from there start a training to train the movements associated with moving in and out of bed but also with walking backwards and this can be partly task specific but also as a whole in the water. 

Photo 9 shows the chair lift in the bath, and of course, the effect of water on muscle tone won't be optimal yet, but we can use the chair at any time to practice getting up and also to train according to the training rules. [44,45]

Fall training for this group is "utopian," yet the section on practicing the backward movement is very useful for practicing movements in and out of bed and walking backward.

Picture 5: Kneeling on a raised platform in the pool (step board) is very difficult for many older adults with and without neurological disorders.  People who have suffered a stroke, in particular, have considerable difficulty flexing their knees while maintaining hip extension. This selectivity is often impossible on land for people who require extension synergy to bear weight (with pathologically high muscle tone) because all leg joints are flexed[63,64,65]. However, the buoyancy of the water can reduce this high muscle tone and lessen the inhibition on selectivity, making this movement—possibly with guidance—possibly possible.

The advantage of this kneeling exercise is that it allows you to work on training the hip extension muscles and thus maintain this selectivity longer. Many movements require selectivity in the hips, from movements in and out of bed, getting up, and walking/climbing stairs.

Picture 6: Training the muscle patterns associated with walking, as well as moving in and out of bed. This requires establishing 1 RM and then performing 10 repetitions three times in a row. This should be done 2-3 times during this session, at least twice a week.

Performing this exercise while lying down will cause a reaction throughout the body. Resistance against the heel during extension will cause hip flexion in the other leg, but the opposite reaction in the arm, as we see when people walk [26]. So, with this training, we can also train turning in water against resistance. However, it is essential that the training rules (picture 6) are followed so that muscle fatigue occurs, which is the necessary stimulus for improving coordination and power.

Pictures 7 and 8: Resistance to the swing leg to train the other leg. Picture 7 focuses on the extension pattern of the other leg during a specific phase of the gait. Picture 8 focuses more on the abductors on the other side. Training according to the training rules[43,44,45]

Recent research [66] also showed that foot training can help with optimal balance control, and this group, in particular, has considerable potential. Walking on toes and heels will be impossible on land, but water, with the right water level, provides an excellent environment for optimal muscle training. This can be achieved simply by walking on toes or heels, but also by demanding more of the foot muscles to maintain balance.

Photo 9, 10, and Picture 9: Reaching requires the utmost effort, even standing on your toes.  Walking on a balance beam, on the other hand, demands a great deal of footwork, both in terms of feeling (perception) and control in the foot itself. Walking and simultaneously controlling boards under your feet requires a lot of foot selectivity, i.e., foot muscles, but also foot perception, because you have to feel that the board is still where it should be and you have to learn to react to that when it moves. And here's a combination of standing on it and moving forward without the board shooting up, and doing so with various water levels.

Group therapy is often possible but requires a great deal of guidance The water environment forces each person to develop their own control, but because abilities often vary so much, this requires much closer supervision. However, exercises can easily be done with two or three people, such as exercises to practice standing up and sitting down, as well as strength training to improve coordination and power according to training guidelines. 

Pictures 10 and 11. Picture 10: Two people "make" a chair, and the third participant tries to sit, lie down, and stand up on it. The "chair" tries to facilitate this, but the opposite is also possible, making sitting, lying down, and standing up increasingly difficult.

Picture 11 shows a game between two participants in which they, standing on one leg, try to unbalance the other so that he has to pivot with his standing leg, etc.

Conclusion:

This article is no longer about restoring balance control/restoration through training, but rather about developing training programs for a group of patients to maintain their limited balance as effectively as possible, or even improve certain aspects. The reason we chose water for them is primarily because movement is much easier in water, and this immediately has positive effects on general fitness, blood circulation, and sleep. [67,68] However, water also has a positive effect on pathological tonus in many participants in this group due to underlying neurological conditions, resulting in a loss of selectivity essential for balance control and recovery. This increase in tonus is necessary on land, but in water it clearly decreases, revealing which potentials are still present and therefore trainable in water.

To train this, training must be done according to the training rules, which means establishing a 1 RM for a task-specific movement. This is the basis for resistance training, with 75% of that 1 RM repeated 10 times in a row, and 2 x 3 x 10 repetitions per session. Essential is the reduction in power development around the 8th repetition and rapid recovery after a short rest. This muscle fatigue is the stimulus needed to improve the coordination and power of the muscle patterns. This program should be performed at least twice a week. This is often the problem because it is not applied, resulting in no improvement, which could be achieved. This also means that nothing extra can be transferred to movements on land. In this case, there will be little or no transfer of the training, and research that differs the weekly frequency between training on land and water is therefore unreliable.

Exercising in water makes selective movement possible again, which is necessary for balance control!

References

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Aibing Rao

I Appreciate the Opportunity to Share my Experience with the Journal of Clinical Research and Reports. The peer review process was timely and constructive, and the feedback provided helped improve the quality of our manuscript. The editorial office was professional, responsive, and supportive throughout the process, ensuring smooth communication and efficient handling of the submission. Overall, it was a positive experience collaborating with your team.

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Kashani Mehdi

Dear Mercy Grace, Editorial Coordinator of Obstetrics Gynecology and Reproductive Sciences, We would like to express our gratitude for your help at all stages of publishing and editing the article. The editors of the magazine answer all the necessary questions and help at every stage. We will definitely continue to cooperate and publish other works in the Obstetrics Gynecology and Reproductive Sciences! Best wishes from, Alla Konstantinovna Politova,

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Alla Konstantinovna Politova

Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.

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Perlat Kapisyzi

Dear Reader: We have published several articles in the Auctores Publishing, LLC, journal, Clinical Medical Reviews and Reports in recent years (CMRR). This is an ‘open access’ journal and the following are our observations. From the initial invitation to submit an article, to the final edits of galley proofs, we have found CMRR personnel to be professional, responsive, rapid and thorough. This entire process begins with Catherine Mitchell, Editorial Coordinator. She is simply outstanding, and, I believe, unparalleled in her capacity. I cannot imagine a more responsive and dedicated Editorial Coordinator. As I read the dates and timing of her correspondence with us, it seems that she never sleeps. I hope Auctores Publishing, LLC, appreciates her efforts as much as these authors do. Thank you to Auctores Publishing, LLC, to the Editorial Staff/Board, and to Catherine Mitchell from a grateful author(s).

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Dr Gary Merrill

Dear Maria Emerson, Editorial Coordinator of - Journal of Clinical Research and Reports. ''I am pleased to provide this testimonial following the publication of our recent case report in this journal. The peer review process was rigorous, constructive, thorough, and conducted in a timely manner. The reviewers’ comments were thoughtful, detailed, and highly constructive, contributing substantially to the refinement, clarity, and scientific robustness of our manuscript. The process was conducted with professionalism and academic integrity throughout. The support provided by the editorial office was exemplary. Communication was consistently prompt, clear, and courteous at all stages of the submission and publication process. The editorial team demonstrated a high level of organization and responsiveness, ensuring that all queries were addressed efficiently and that the process remained transparent and well-coordinated. The overall quality of the journal is reflected in its strong editorial standards, commitment to scientific excellence, and dedication to publishing clinically meaningful research. It has been a privilege to publish our work in this journal, and we would welcome the opportunity to contribute further in the future.'' Best wishes from, Dr. Efstratios Trogkanis, Cardiologist.

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Dr Efstratios Troganis

Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).

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Dr SABITA SINHA

Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.

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Dr Ted Christopher

International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.

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Joel Yat Seng Wong

Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.

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Dr Mamoun Magzoub

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.

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Baciulescu Laura

Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal

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Christoph Maurer

Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.

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Dr Elena Salvatore

Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed

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Mahmoud Kamal Moustafa Ahmed

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.

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Dr Meng-JouLe

Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell

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Dr Andriy Sinelnyk

I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.

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Edouard Kujawski

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. Matteo Bonori.

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Dr Matteo Bonori

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

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Dr Claudio Ligresti

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.

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Dr Chiara Giuseppina Beccaluva

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.

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Dr Aline Tollet

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.

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Dr Ravi Shrivastava

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

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Dariusz Ziora

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.

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Dr Jelle Lettinga

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.

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Dr Walter F Riesen

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.

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Dr Rakhi Mishra

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.

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Hala Al Shaikh

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

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Dr Eric S Nussbaum

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.

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Dr Susan Anne Smith

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.

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Dr Victor Olagundoye

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.

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Dr Farahnaz Fallahian

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.

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Dr Susan Anne Smith

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.

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Dr Oleg Golyanovski

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

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Dr Elvira Farina

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.

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Gertraud Teuchert-Noodt

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.

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Dr David Vinyes

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.

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Dr Anyuta Ivanova

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.

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Dr Farooq Wandroo

"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".

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Dr Shweta Tiwari

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.

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Dr Tewodros Kassahun Tarekegn

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.

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Cristina Berriozabal

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."

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Thomas Urban

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.

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Zhao Jia

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.

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Luiz Sellmann

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.

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Sonila Qirko

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.

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Lin-Show Chin

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

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Dr Susan Weiner

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!”

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Zsuzsanna Bene

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¨.

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Dr Maria Regina Penchyna Nieto

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.

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Dr Maria Dolores Gomez Barriga

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.

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Maria Dolores Gomez Barriga

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.

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Lin Shaw Chin

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.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

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.

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Rui Tao

“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”.

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George Varvatsoulias

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.

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Tania Munoz

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.

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S Munshi

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.

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Husain Taha Radhi

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.

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Dr Tong Ming Liu

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.

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Dr Griffith

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.

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Douglas Miyazaki

"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".

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Jesus Simal-Gandara

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

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Anthony Kodzo-Grey Venyo

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Katarzyna Byczkowska

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

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Orlando Villarreal

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Sing-yung Wu

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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Layla Shojaie

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig