Symptom Exacerbation Following Mental Imagery in Patients With Persistent Post-Concussive Symptoms

NCT07166536 | Recruiting

• 1 other identifier: 0003-25-RRH
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Mild Traumatic Brain Injury (mTBI) often results in persistent emotional, cognitive, and somatic symptoms-such as headaches and dizziness. These symptoms impose a significant burden, yet their underlying mechanisms remain unclear. Predictive processing theories suggest that persistent symptoms may result from learned perceptual errors, particularly in individuals with high negative affectivity. This framework may help explain ongoing persistent post-concussive symptoms (PPCS) in the absence of identifiable pathology, which have been linked to various psychological factors. Mental imagery (MI) is thought to engage similar predictive processes. There is evidence that MI of symptom-triggering movements may exacerbate symptoms in individuals with chronic somatic conditions. However, this phenomenon has not been studied in PPCS patients. Investigating symptom provocation through MI may yield novel insights into the neuropsychological mechanisms sustaining PPCS and potentially contribute to the development of therapeutic tools for this population. Objectives:

1. 1.Documenting the exacerbation of headache and dizziness following provocative mental imagery (imagery of movements or scenarios that elicit these symptoms in real life) in patients with PPCS.
2. 2.Comparing changes in headache and dizziness after provocative MI versus neutral MI (imagery of movements or scenarios that do not elicit these symptoms in real life).
3. 3.Comparing patients who experience symptom exacerbation following mental imagery to those who do not.
4. 4.Describing associations between symptom exacerbation and negative affectivity, anxiety, depression, catastrophizing, and lower daily functioning.

Conditions

Post Concussive Syndrome, Chronic; Post Traumatic Headache; Mild Traumatic Brain Injury, Concussion

Keywords

mild traumatic brain injury; Persistent Post-Concussion Symptoms; mental imagery; concussion

Outcome Measures

Primary Outcomes (2)

• Headache intensity Change

  Measured on a 100mm Visual Analog Scale from 0 ("no Pain") to 100 ("most severe Pain")

  Immediately before and after the intervention at assessment session 2

• Dizziness intensity change

  Measured on a 100mm Visual Analog Scale from 0 ("no dizziness") to 100 ("most severe dizziness")

  Immediately before and after the intervention at assessment session 2

Secondary Outcomes (9)

• Headache Impact on Daily life

  Within 1-2 weeks before the intervention

• Post-Concussion Symptoms

  Within 1-2 weeks before the intervention

• Perceived disability due to dizziness

  Within 1-2 weeks before the intervention

• Pain Catastrophizing

  Within 1-2 weeks before the intervention

• Anxiety

  Within 1-2 weeks before the intervention

Study Arms (1)

Mental Imagery Provocation Testing

EXPERIMENTAL

Provocation Test for Symptoms Using Mental Imagery: 1. Baseline symptom intensity (dizziness/headache) will be measured using the VAS scale. 2. Instruction to perform the movement that is hypothesized to provoke the symptom in reality for approximately 10-20 seconds 3. Measurement of symptom intensity using the VAS scale following the provoked movement. 4. Rest period of several minutes. 5. Measurement of symptom intensity following rest using the VAS scale. 6. Instruction to mentally imagine the movement or scenario hypothesized to provoke the symptom in reality for approximately 10-20 seconds 7. Measurement of symptom intensity using the VAS scale following mental imagery. 8. Measurement of imagery vividness using the VAS-V scale.

Other: Provocation Test for Symptoms Using Mental Imagery

Interventions

Provocation Test for Symptoms Using Mental Imagery OTHER

• The mental imagery task will be guided by the examiner through continuous verbal instruction (the examiner will provide ongoing instructions throughout the entire task, not just at the beginning). During the instruction, the examiner will direct the participant's attention to visual, auditory, and proprioceptive aspects of the imagined movement or scenario. Example: "Close your eyes, and without moving your head or body at all, try to imagine that you are moving your head from side to side quickly and easily, while noticing the sensation of motion, seeing the rotation through your eyes, and feeling the acceleration of your head as it moves from side to side..."

Mental Imagery Provocation Testing

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Current patients of Reut Rehabilitation Hospital or individuals who were discharged from the hospital within the past 12 months.
• Diagnosis of mild Traumatic Brain Injury, concussion, blast injury, or cervical whiplash injury.
• More than 3 months since the event.
• Presence of headaches and/or dizziness that began after the injury and have persisted continuously or intermittently.
• Headache intensity of at least 3/10 on the VAS scale.

You may not qualify if:

• Significant cognitive impairment preventing informed consent (Mini-Mental State Examination score \<20 or Montreal Cognitive Assessment score \<20, as per IRB requirements).
• Diagnosed central neurological conditions such as multiple sclerosis, Parkinson's disease, stroke, or brain tumor.
• Presence of known pyramidal or extrapyramidal neurological signs.
• Significant language impairment interfering with communication.
• Psychiatric disorders significantly affecting communication.
• Use of vestibular-suppressant medication (e.g., Cinnarizine) with an inability or unwillingness to discontinue treatment 24 hours prior to testing.
• Withdrawal Criteria:
• \. Oculomotor dysfunction affecting multiple oculomotor functions.

Sponsors & Collaborators

• Reuth Rehabilitation Hospital: lead

Study Sites (1)

Reuth Rehabilitation Hospital

Tel Aviv, Israel

RECRUITING

Related Publications (5)

• Polinder S, Cnossen MC, Real RGL, Covic A, Gorbunova A, Voormolen DC, Master CL, Haagsma JA, Diaz-Arrastia R, von Steinbuechel N. A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Front Neurol. 2018 Dec 19;9:1113. doi: 10.3389/fneur.2018.01113. eCollection 2018.

  PMID: 30619066 BACKGROUND

• de Neeling M, Liessens D, Depreitere B. Relationship between psychosocial and psychiatric risk factors and poor long-term outcome following mild traumatic brain injury: A systematic review. Eur J Neurol. 2023 May;30(5):1540-1550. doi: 10.1111/ene.15713. Epub 2023 Feb 15.

  PMID: 36708085 BACKGROUND

• Dijkstra N, Bosch SE, van Gerven MAJ. Shared Neural Mechanisms of Visual Perception and Imagery. Trends Cogn Sci. 2019 May;23(5):423-434. doi: 10.1016/j.tics.2019.02.004. Epub 2019 Mar 12.

  PMID: 30876729 BACKGROUND

• Van den Bergh O, Witthoft M, Petersen S, Brown RJ. Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev. 2017 Mar;74(Pt A):185-203. doi: 10.1016/j.neubiorev.2017.01.015. Epub 2017 Jan 17.

  PMID: 28108416 BACKGROUND

• Moseley GL, Zalucki N, Birklein F, Marinus J, van Hilten JJ, Luomajoki H. Thinking about movement hurts: the effect of motor imagery on pain and swelling in people with chronic arm pain. Arthritis Rheum. 2008 May 15;59(5):623-31. doi: 10.1002/art.23580.

  PMID: 18438892 BACKGROUND

MeSH Terms

Conditions

Brain Concussion; Post-Concussion Syndrome; Post-Traumatic Headache

Condition Hierarchy (Ancestors)

Brain Injuries, Traumatic; Brain Injuries; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds and Injuries; Wounds, Nonpenetrating; Headache Disorders, Secondary; Headache Disorders

Study Officials

• Keren Sivan-Speier, MD

  Reuth Rehabilitation Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Yotam Yanai, BPT

CONTACT

972523993918; yanayot@gmail.com

Gali Pinsky, BPT

CONTACT

972546326566; galipinsky95@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 3, 2025
• First Posted: September 10, 2025
• Study Start: September 7, 2025
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: April 14, 2026

Record last verified: 2025-09

Locations

IL (1)