Vestibular HypofunctionEMINCT07064096
Effects Of Mental Imagery Along With Vestibular Rehabilitation On Young Adults With Vestibular Hypofunction
A study testing cawthorne cooksey exercise and mental imagery in people with Vestibular Hypofunction, run by Riphah International University at 2 sites in Pakistan.
Trial summary
The objective of the study is to determine the effects of cawthorne cooksey exercises with addition of mental imagery on vertigo,dizziness and balance in young adults with vestibular hypofunctionThe study will be randomized control trial including 2 experimental groups with estimated 22 participants in each group. Read more about this study
- Who is it for?
- Ages 20 to 40 years
- Conditions the study is for
- Vestibular Hypofunction
- What is being tested?
- cawthorne cooksey exercise and mental imagery
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 44 participants
- Where
- 2 sitesPakistan
- Study dates
- 1 Jul 2025to 30 Dec 2025
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Patients with unilateral vestibular hypofunction
- Head thrust test positive
- Age group 20-40
- DHI score 16 above
- VSS score 11-30
Who cannot join
- With any other associated neurological disorder that effect vestibular rehabilitation
- Having bilateral vestibular hypofunction
- Patients having any other associated disease that affects balance or cause vertigo other that vestibular
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan2 sites, 2 recruiting
- Recruiting
Alnasir Hospital Gujar Khan
Gujar Khān, Punjab Province, 447150
FAHEEM AHMED, 00923044608855, mdawood650@gmail.com
- Recruiting
Riphah International University
Islamabad
About this study
The objective of the study is to determine the effects of cawthorne cooksey exercises with addition of mental imagery on vertigo,dizziness and balance in young adults with vestibular hypofunctionThe study will be randomized control trial including 2 experimental groups with estimated 22 participants in each group.
Read the detailed description
The vestibular system detects motion of the head in space and in turn generates reflexes that are crucial for our daily activities, such as stabilizing the visual axis (gaze) and maintaining head and body posture. The vestibular system is comprised of two types of sensors: the two otolith organs (the saccule and utricle), which sense linear acceleration, and the three semicircular canals, which sense angular acceleration in three planes. The receptor cells of the otoliths and semicircular canals send signals through the vestibular nerve fibers to the neural structures that control eye movements, posture, and balance.
Vestibular hypofunction i.e. a unilateral or a bilateral vestibulopathy, is a heterogeneous disorder of the peripheral and/or rarely central vestibular system leading typically to disabling symptoms such as dizziness, imbalance, and/or oscillopsia.
Mental imagery (MI), also known as motor imagery or cognitive rehearsal, is the mental simulation of physical movement without actual execution. MI activates similar brain regions involved in physical movement and has been shown to improve motor performance, balance, and functional outcomes in various populations. However, its application in conjunction with vestibular rehabilitation for individuals with vestibular hypofunction remains underexplored.
This study aims to investigate the combined effect of mental imagery and vestibular rehabilitation exercises on balance, dizziness, and vertigo in young adults diagnosed with vestibular hypofunction. The intervention will involve a structured VR program integrated with guided mental imagery sessions targeting balance and gaze stabilization tasks.
Participants will be randomly assigned to two groups: one receiving only vestibular rehabilitation i.e cawthorne-cooksey exercises and the other receiving both VR and mental imagery training. Outcome measures such as the Dizziness Handicap Inventory (DHI), Mini-BESTest (Mini Balance Evaluation Systems Test and Vertigo Symptom Scale will be used to assess changes pre- and post-intervention.
This research intends to determine whether the addition of mental imagery enhances the efficacy of vestibular rehabilitation in restoring functional balance and reducing dizziness symptoms. The findings could contribute to developing more comprehensive and accessible rehabilitation strategies for managing vestibular disorders in young adults.
- Conditions
- Vestibular Hypofunction
- Being tested
- cawthorne cooksey exercise, mental imagery
- Keywords
- VESTIBULAR REHAB WITH MENTAL IMAGERY, BALANCE, VERTIGO AND DIZZINESS
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
cawthorne cooksey exerciseOther
Also called cawthorne cooksey exercises
Cawthorne Cooksey exercises -Start with low to moderate intensity. Cawthorne Cooksey exercise Training Phase1-In bed exerercises:- Eye movements: 1)Up and down 2)Side to side 3)Moving finger away from face -Phase2-Sitting: Eye movements as above. Head movements at firsts low, then quick later with eyes closed -bending forward and backward -turning from side to side. --Shoulder shrugging and circling -Bending forward and picking up objects from the ground - Phase 3 - Standing: -Eye, Head, Shoulder movements -Throwing ball from hand to hand, hand under knee -Switch to sitting to standing and turning around in between. -Phase 4 - Walk: with eyes closed and open: -Across room -Slope and Stairs
mental imageryOther
The mental imagery intervention in this study is a structured, guided cognitive training program designed to enhance the effects of vestibular rehabilitation in young adults with unilateral vestibular hypofunction. Mental imagery (MI) involves the internal visualization and mental rehearsal of physical movements without actual motor output, engaging similar neural pathways as actual execution.
| Study group | Role | What they receive |
|---|---|---|
| Conventional treatment | Active comparator | cawthorne cooksey exercises Receives: Other: cawthorne cooksey exercise |
| participatory Group | Experimental | cawthorne cooksey exercises in addition of mental imagery Receives: Other: mental imagery |
What is being measured
The primary outcome is the main question the study is designed to answer.
Vertigo Symptom Scale
The Vertigo Symptom Scale (VSS) is a self-report questionnaire designed to assess the severity and frequency of vertigo-related symptoms over the past month
Measured: 8 week
• Dizziness Handicap Inventory
The Dizziness Handicap Inventory (DHI) is a self-reported questionnaire designed to evaluate the impact of dizziness on a person's daily life, emotional well-being, and functional ability. It is widely used in clinical practice for assessing vestibular dysfunction and tracking progress in rehabilitation. Purpose of DHI is to Measures how dizziness affects daily activities.
Measured: 8 week
Mini-BESTest (Mini Balance Evaluation Systems Test)
The Mini-BESTest is a shortened version of the Balance Evaluation Systems Test (BESTest). It is designed to assess dynamic balance and identify impairments in postural control across different systems. This test is particularly useful for evaluating balance deficits in vestibular disorders
Measured: 8 week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Jul 2025
- Study start1 Jul 2025
- Primary completion30 Dec 2025 (estimated)
- Study completion30 Dec 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Vestibular HypofunctionStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Interventional model
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 44 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Nadia azhar, MS, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07064096
- Sponsor's protocol ID
- Sulman amjad
- Acronym
- EMI
- Status last verified
- Jul 2025
- First submitted
- 3 Jul 2025
- Last updated
- 14 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Liu KP, Chan CC, Lee TM, Hui-Chan CW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2004 Sep;85(9):1403-8. doi: 10.1016/j.apmr.2003.12.035.
PubMed 15375808Ellis AW, Schone CG, Vibert D, Caversaccio MD, Mast FW. Cognitive Rehabilitation in Bilateral Vestibular Patients: A Computational Perspective. Front Neurol. 2018 Apr 27;9:286. doi: 10.3389/fneur.2018.00286. eCollection 2018.
PubMed 29755404van Esch BF, Nobel-Hoff GE, van Benthem PP, van der Zaag-Loonen HJ, Bruintjes TD. Determining vestibular hypofunction: start with the video-head impulse test. Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3733-3739. doi: 10.1007/s00405-016-4055-9. Epub 2016 Apr 25.
PubMed 27113255
Study at a glance
From the registry record, last updated by the sponsor on 14 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects Of Mental Imagery Along With Vestibular Rehabilitation On Young Adults With Vestibular Hypofunction
- ClinicalTrials.gov ID
- NCT07064096
- Acronym / sponsor ID
- EMI / Sulman amjad
- Conditions
- Vestibular Hypofunction
- Keywords
- VESTIBULAR REHAB WITH MENTAL IMAGERY, BALANCE, VERTIGO AND DIZZINESS
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 44 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 1 Jul 2025 (actual)
- Primary completion
- 30 Dec 2025 (estimated)
- Study completion
- 30 Dec 2025 (estimated)
- First posted
- 14 Jul 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The objective of the study is to determine the effects of cawthorne cooksey exercises with addition of mental imagery on vertigo,dizziness and balance in young adults with vestibular hypofunctionThe study will be randomized control trial including 2 experimental groups with estimated 22 participants in each group.
Detailed description
The vestibular system detects motion of the head in space and in turn generates reflexes that are crucial for our daily activities, such as stabilizing the visual axis (gaze) and maintaining head and body posture. The vestibular system is comprised of two types of sensors: the two otolith organs (the saccule and utricle), which sense linear acceleration, and the three semicircular canals, which sense angular acceleration in three planes. The receptor cells of the otoliths and semicircular canals send signals through the vestibular nerve fibers to the neural structures that control eye movements, posture, and balance.
Vestibular hypofunction i.e. a unilateral or a bilateral vestibulopathy, is a heterogeneous disorder of the peripheral and/or rarely central vestibular system leading typically to disabling symptoms such as dizziness, imbalance, and/or oscillopsia.
Mental imagery (MI), also known as motor imagery or cognitive rehearsal, is the mental simulation of physical movement without actual execution. MI activates similar brain regions involved in physical movement and has been shown to improve motor performance, balance, and functional outcomes in various populations. However, its application in conjunction with vestibular rehabilitation for individuals with vestibular hypofunction remains underexplored.
This study aims to investigate the combined effect of mental imagery and vestibular rehabilitation exercises on balance, dizziness, and vertigo in young adults diagnosed with vestibular hypofunction. The intervention will involve a structured VR program integrated with guided mental imagery sessions targeting balance and gaze stabilization tasks.
Participants will be randomly assigned to two groups: one receiving only vestibular rehabilitation i.e cawthorne-cooksey exercises and the other receiving both VR and mental imagery training. Outcome measures such as the Dizziness Handicap Inventory (DHI), Mini-BESTest (Mini Balance Evaluation Systems Test and Vertigo Symptom Scale will be used to assess changes pre- and post-intervention.
This research intends to determine whether the addition of mental imagery enhances the efficacy of vestibular rehabilitation in restoring functional balance and reducing dizziness symptoms. The findings could contribute to developing more comprehensive and accessible rehabilitation strategies for managing vestibular disorders in young adults.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
- Model description
- Interventional model
| Arm | Type | Receives |
|---|---|---|
| Conventional treatment | Active comparator | Other: cawthorne cooksey exercisecawthorne cooksey exercises |
| participatory Group | Experimental | Other: mental imagerycawthorne cooksey exercises in addition of mental imagery |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Patients with unilateral vestibular hypofunction
- Head thrust test positive
- Age group 20-40
- DHI score 16 above
- VSS score 11-30
Key exclusion criteria (3 listed)
- With any other associated neurological disorder that effect vestibular rehabilitation
- Having bilateral vestibular hypofunction
- Patients having any other associated disease that affects balance or cause vertigo other that vestibular
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| cawthorne cooksey exerciseAlso: cawthorne cooksey exercisesCawthorne Cooksey exercises -Start with low to moderate intensity. Cawthorne Cooksey exercise Training Phase1-In bed exerercises:- Eye movements: 1)Up and down 2)Side to side 3)Moving finger away from face -Phase2-Sitting: Eye movements as above. Head movements at firsts low, then quick later with eyes closed -bending forward and backward -turning from side to side. --Shoulder shrugging and circling -Bending forward and picking up objects from the ground - Phase 3 - Standing: -Eye, Head, Shoulder movements -Throwing ball from hand to hand, hand under knee -Switch to sitting to standing and turning around in between. -Phase 4 - Walk: with eyes closed and open: -Across room -Slope and Stairs | Other | Conventional treatment |
| mental imageryThe mental imagery intervention in this study is a structured, guided cognitive training program designed to enhance the effects of vestibular rehabilitation in young adults with unilateral vestibular hypofunction. Mental imagery (MI) involves the internal visualization and mental rehearsal of physical movements without actual motor output, engaging similar neural pathways as actual execution. | Other | participatory Group |
Primary outcome
Vertigo Symptom Scale
Time frame: 8 week
The Vertigo Symptom Scale (VSS) is a self-report questionnaire designed to assess the severity and frequency of vertigo-related symptoms over the past month
• Dizziness Handicap Inventory
Time frame: 8 week
The Dizziness Handicap Inventory (DHI) is a self-reported questionnaire designed to evaluate the impact of dizziness on a person's daily life, emotional well-being, and functional ability. It is widely used in clinical practice for assessing vestibular dysfunction and tracking progress in rehabilitation. Purpose of DHI is to Measures how dizziness affects daily activities.
Mini-BESTest (Mini Balance Evaluation Systems Test)
Time frame: 8 week
The Mini-BESTest is a shortened version of the Balance Evaluation Systems Test (BESTest). It is designed to assess dynamic balance and identify impairments in postural control across different systems. This test is particularly useful for evaluating balance deficits in vestibular disorders
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Jul 2025.
- Background: PubMed 15375808Liu KP, Chan CC, Lee TM, Hui-Chan CW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2004 Sep;85(9):1403-8. doi: 10.1016/j.apmr.2003.12.035.
- Background: PubMed 29755404Ellis AW, Schone CG, Vibert D, Caversaccio MD, Mast FW. Cognitive Rehabilitation in Bilateral Vestibular Patients: A Computational Perspective. Front Neurol. 2018 Apr 27;9:286. doi: 10.3389/fneur.2018.00286. eCollection 2018.
- Background: PubMed 27113255van Esch BF, Nobel-Hoff GE, van Benthem PP, van der Zaag-Loonen HJ, Bruintjes TD. Determining vestibular hypofunction: start with the video-head impulse test. Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3733-3739. doi: 10.1007/s00405-016-4055-9. Epub 2016 Apr 25.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Nadia azhar, MS principal investigator
Riphah International University
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing cawthorne cooksey exercise and mental imagery in people with Vestibular Hypofunction, run by Riphah International University at 2 sites in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 14 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Nadia Azhar, MSNMPT (00923335281431, Nadia.azhar@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Vertigo Symptom Scale (time frame: 8 week). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07064096, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Jul 2025.