Forward Head Posture Correction on Cerebral Oxygenation During Dual-task in Symptomatic Subjects (FHP)

May 4, 2026 updated by: Reime Jamal Shehadeh Shalash, University of Sharjah

Effects of Forward Head Posture Correction on Prefrontal Cerebral Oxygenation During Cognitive-Motor Interference in Symptomatic Subjects With Forward Head Posture: A Randomized Controlled Trial

This study aims to investigate the effects of forward head posture correction on neck pain, brain activity, and cognitive-motor performance. Forward head posture is a common postural problem, especially among young adults who spend long hours using smartphones and computers. It is frequently associated with neck pain, reduced mobility, and functional limitations. Emerging evidence also suggests that this postural deviation may influence brain function and increase the mental effort required during tasks that involve both thinking and movement.

Participants with forward head posture and neck pain will be recruited and randomly assigned to one of three groups: an intervention group using a cervical traction device (Denneroll), a sham group using a towel roll, or a control group receiving no intervention. The intervention will be performed at home over a six-week period, with sessions conducted five times per week. The duration of each session will gradually increase based on participant tolerance to ensure safety and comfort.

All participants will undergo assessments at baseline and after the intervention period. Pain intensity will be measured using a standardized pain scale. Brain activity will be assessed using a non-invasive technique called functional near-infrared spectroscopy (fNIRS), which measures changes in oxygen levels in the brain. Participants will also perform balance tasks under single-task and dual-task conditions, where they will be asked to maintain balance while performing simple cognitive tasks. In addition, cognitive function will be evaluated using standardized tests of attention, memory, and overall cognitive performance.

This study will help determine whether correcting forward head posture can reduce pain and improve brain and cognitive function. The findings may provide valuable insights into the relationship between posture, pain, and brain activity, and may contribute to the development of more effective and comprehensive rehabilitation approaches for individuals with forward head posture.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Forward head posture (FHP) is a common postural deviation associated with neck pain, impaired sensorimotor control, and functional limitations. In addition to musculoskeletal effects, emerging evidence suggests that FHP may influence cortical activity, particularly within prefrontal regions involved in attention and cognitive-motor integration. Individuals with FHP have demonstrated increased cognitive-motor interference during dual-task performance, indicating greater reliance on cortical resources and reduced motor automaticity. However, it remains unclear whether correcting FHP can reduce pain and modify these neurophysiological responses.

This study aims to investigate the effects of forward head posture correction on pain intensity as a primary outcome, alongside task-evoked cerebral oxygenation and cognitive-motor interference. A prospective, single-blinded, randomized controlled trial design with three parallel groups will be used. Participants with symptomatic FHP will be randomly allocated to an intervention group receiving Denneroll cervical traction, a sham group receiving a non-therapeutic towel roll intervention, or a control group receiving no intervention.

The intervention will be conducted over six weeks, with participants in the intervention and sham groups performing home-based sessions with gradual progression in duration to ensure safety and tolerance. All participants will undergo assessments at baseline and post-intervention.

Pain intensity will be evaluated using the Visual Analog Scale (VAS). Neurophysiological outcomes will be assessed using functional near-infrared spectroscopy (fNIRS) to measure changes in oxygenated and deoxygenated hemoglobin in the prefrontal cortex during rest, single-task, and dual-task conditions. Cognitive-motor interference will be examined using dual-task paradigms that combine balance tasks with cognitive demands. Cognitive function and balance performance will also be evaluated using standardized assessments.

The procedures used in this study are non-invasive and associated with minimal risk. The fNIRS device does not emit radiation, and the intervention may cause only mild and temporary discomfort, which will be minimized through gradual progression and monitoring. Participants will be informed of their right to withdraw at any time without consequences.

By integrating clinical, cognitive, and neurophysiological outcomes, this study aims to provide a comprehensive understanding of the effects of forward head posture correction. The findings may contribute to the development of more effective, mechanism-based rehabilitation strategies targeting both pain and brain function in individuals with forward head posture.

Study Type

Interventional

Enrollment (Estimated)

45

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Reime Jamal Shehadeh Shalash, PhD-Teaching assistant
  • Phone Number: +971 52-5568334
  • Email: reemjamal25@gmail.com

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Young adults of both sexes aged 18-35 years
  • Individuals with forward head posture (a craniovertebral angle (CVA) < 50°)
  • Presence of neck pain with an intensity of ≥3 on the Visual Analog Scale (VAS)
  • Ability to understand and follow basic English instructions
  • No cognitive impairment (score >18 on the Montreal Cognitive Assessment (MoCA))

Exclusion Criteria:

  • History of cervical spine surgery or significant cervical trauma
  • Currently receiving physiotherapy or rehabilitation for cervical spine conditions
  • Individuals on medications (diagnosed neurological disorders)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Denneroll group (DG)
The intervention group will receive Denneroll cervical traction
Other: Forward Head Posture Correction

Duration: 6 weeks Frequency: 5 sessions per week (total 30 sessions) Setting: Home-based Position: Supine Session duration: Starts at ~3 minutes, progressively increased to 15-20 minutes (as tolerated)

- Intervention: DG: The denneroll will be given under the cervical spine (based on deviation level) TG: A towel roll will be given as an intervention CG: No intervention

This protocol simultaneously examines cerebral oxygenation using functional near-infrared spectroscopy (fNIRS)(HbO and HbR) , during single- and dual-task balance conditions(cognitive load-motor balance), and pain intensity using the VAS, postural alignment (craniovertebral angle),and cognitive function (MoCA, SDMT, BVMT-R) before and after intervention.
Sham Comparator: Towel group (TG)
The placebo group will receive a towel roll as an intervention
Other: Forward Head Posture Correction

Duration: 6 weeks Frequency: 5 sessions per week (total 30 sessions) Setting: Home-based Position: Supine Session duration: Starts at ~3 minutes, progressively increased to 15-20 minutes (as tolerated)

- Intervention: DG: The denneroll will be given under the cervical spine (based on deviation level) TG: A towel roll will be given as an intervention CG: No intervention

This protocol simultaneously examines cerebral oxygenation using functional near-infrared spectroscopy (fNIRS)(HbO and HbR) , during single- and dual-task balance conditions(cognitive load-motor balance), and pain intensity using the VAS, postural alignment (craniovertebral angle),and cognitive function (MoCA, SDMT, BVMT-R) before and after intervention.
No Intervention: control group (CG)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The visual analog scale
Time Frame: Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
The Visual Analog Scale (VAS) is a validated measure of pain intensity, typically presented as a 10 cm (100 mm) horizontal line. The scale ranges from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst imaginable pain." Higher scores represent greater pain intensity.
Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Technobody Balance System (Balance performance)
Time Frame: Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Balance performance measurements will be evaluated using the Technobody Balance System under both single-task and dual-task conditions.
Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
functional near-infrared spectroscopy
Time Frame: Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).

cerebral oxygenation using functional near-infrared spectroscopy (fNIRS):

Task-evoked cerebral:

Changes in oxygenated (ΔHbO) and deoxygenated hemoglobin (ΔHbR) at rest, and during single-task and dual-task conditions will be calculated relative to pre-task baseline

Cortical dual-task cost:

The difference between dual-task and single-task ΔHbO will be used as an index of cognitive-motor interference.
Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Symbol Digit Modalities Test
Time Frame: Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Symbol Digit Modalities Test (SDMT) is used to assess divided attention, visual scanning, tracking and motor speed. The SDMT presents a series of nine symbols, each paired with a single digit in a key at the top of the sheet. The participants will be asked to pair specific numbers with given geometric figures within 90 s using a reference key. The participants should respond by voicing the digit associated with each symbol as quickly as possible. SDMT-Incidental learning (IL) will be measured as well. The participants will be asked to recall each geometric figure represented which number after 20 minutes.
Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Brief Visuospatial Memory Test-Revised
Time Frame: Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Brief Visuospatial Memory Test-Revised (BVMT-R) is used to assess visuospatial learning and memory performance. The BVMT-R consists of stimulus card (2 × 3 geometric figures). The researcher will show the participant a stimulus array of six abstract geometric figures for 10 seconds, then the participant will be asked to draw the figures from memory in their correct shape and locations. This procedure will be repeated for three learning trials. The participants will be asked to recall each geometric figure after 20 minutes
Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Montreal Cognitive Assessment
Time Frame: Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).
Montreal Cognitive Assessment (MoCA) is a simple 10 min paper and pencil test, with accepted test-retest reliability and moderate validity, that was developed to detect mild cognitive impairment. The test assesses multiple cognitive domains including memory, language, executive functions, visuospatial skills, calculation, verbal abstraction, attention, concentration, and orientation to time and space. The clinical cut-off score of 26 is recommended.The test and instructions are freely available on the MoCA official website at www.mocatest.org.
Outcome measures will be collected at baseline (week 0) and after completion of the intervention (week 6).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Sharjah

Investigators

  • Principal Investigator: Alham Alsharman, Associate Prof., University of Sharjah

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 1, 2027

Primary Completion (Estimated)

May 1, 2028

Study Completion (Estimated)

September 1, 2028

Study Registration Dates

First Submitted

April 27, 2026

First Submitted That Met QC Criteria

April 27, 2026

First Posted (Actual)

May 4, 2026

Study Record Updates

Last Update Posted (Actual)

May 8, 2026

Last Update Submitted That Met QC Criteria

May 4, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC-26-04-23-05-PG

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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