RecruitingNot Applicable

Effect of Mental Imagery in Patients With Persistent Post-concussion Symptoms

Israel60 participantsStarted 2025-09-07

Plain-language 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. 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. 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. Comparing patients who experience symptom exacerbation following mental imagery to those who do not. 4. Describing associations between symptom exacerbation and negative affectivity, anxiety, depression, catastrophizing, and lower daily functioning. Methods: A single-group, open-label experimental provocation study is being conducted in adult patients with persistent post-concussive symptoms following mild traumatic brain injury. Each participant undergoes all imagery conditions, with the order of provocative and neutral mental imagery stimuli randomized within participants. Participants are recruited by convenience sampling from the computerized patient database of Reuth Rehabilitation Hospital according to the inclusion and exclusion criteria. After signing an informed consent form, participants will be invited to attend 2 to 3 sessions, each lasting 1 to 2 hours. During these sessions, a licensed physiotherapist will conduct a comprehensive clinical assessment, including: Completion of self-report questionnaires; A vestibular examination; Anamnestic interview and clinical assessment of individual movement- and scenario-related triggers for dizziness and headaches; Symptom provocation testing using mental imagery of the identified triggers.

Who can participate

Age range

18 Years – 74 Years

Sex

ALL

See this in plain English?

AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.

Inclusion criteria

. 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.

Exclusion criteria

. Headache intensity of at least 3/10 on the VAS scale.
. Significant cognitive impairment preventing informed consent (Mini-Mental State Examination score \<20 or Montreal Cognitive Assessment score \<20, as per IRB requirements).

Questions worth asking your doctor

Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.

1This study is looking at whether mental imagery can temporarily worsen symptoms like headaches and dizziness in people with persistent post-concussive symptoms — is that kind of symptom provocation safe for someone at my current stage of recovery?
2Since this trial is measuring changes in headache and dizziness intensity, does that mean I'd be asked to do tasks that might actually make my symptoms flare up during the study, and how long might those flare-ups last?
3This study is listed as Phase NA, which often means it's an observational or mechanistic study rather than a treatment trial — so is there any direct therapeutic benefit for me, or is it more about helping researchers understand what drives these symptoms?
4Given that I have persistent post-concussive symptoms, are there standard treatments or rehabilitation approaches I should be trying first before considering participating in a research study like this one?
5Would taking part in this trial affect my current care plan in any way, or could it be done alongside whatever treatment you'd already recommend for my post-concussive headaches and dizziness??

Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.

Questions for the trial coordinator

The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.

1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?

A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.

What they're measuring

Headache intensity Change

Timeframe: Immediately before and after the intervention at assessment session 2

Dizziness intensity change

Timeframe: Immediately before and after the intervention at assessment session 2

Trial details

NCT IDNCT07166536

SponsorReuth Rehabilitation Hospital

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2026-12-31

Contact for this trial

Yotam Yanai, BPT

972523993918 yanayot@gmail.com

View on ClinicalTrials.gov More Mild Traumatic Brain Injury, Concussion trials