The Dizziness Handicap Inventory (DHI) in vestibular physiotherapy in Côte Saint-Luc

1. Why dizziness is more disabling than it looks

Dizziness is one of the most common reasons people over 40 consult a physician — and one of the most under-treated. Unlike a broken ankle, dizziness has no cast, no visible swelling, no obvious mechanism. Patients often hear “your MRI is normal, you're fine” and leave with the impression that their symptoms are imagined. They are not. Chronic dizziness disrupts driving, working at a screen, walking in a mall, climbing stairs at night, and it drags mood and confidence down with it.

Vestibular physiotherapy exists precisely to address this gap. And its most important tool is not a machine — it is a 25-item questionnaire called the Dizziness Handicap Inventory (DHI). At Réhabital in Côte Saint-Luc, we use the DHI at every initial vestibular assessment because it captures what clinical tests miss.

2. What the DHI is

The DHI was published in 1990 by Gary Jacobson, PhD and Craig Newman, PhD at the Henry Ford Hospital in Detroit. It quickly became the international standard for measuring the self-perceived impact of dizziness. It is short (25 questions), free, validated in dozens of languages including French, and requires no equipment — just a pen and 10 minutes.

The 25 items are grouped into three subscales:

• Physical (P) — 7 items, 28 points. Physical movements and postures that provoke dizziness (bending, quick head movements, rolling in bed).
• Emotional (E) — 9 items, 36 points. Fear, embarrassment, frustration, depression and social withdrawal caused by dizziness.
• Functional (F) — 9 items, 36 points. Impact on daily activities: work, chores, driving, socializing, sports.

Each question is answered Yes (4 points), Sometimes (2 points) or No (0 points). Total score ranges from 0 to 100. Higher scores = greater handicap.

3. How to interpret a DHI score

Interpretation follows widely accepted ranges:

• 0 to 30 — mild handicap. Dizziness present but does not dominate life. Home program often sufficient.
• 31 to 60 — moderate handicap. Structured rehabilitation program recommended, 1–2 visits per week.
• 61 to 100 — severe handicap. Significant fall risk, likely work absence, high comorbidity with anxiety and depression. Intensive multidisciplinary care.

The threshold for a clinically meaningful change between two DHI administrations is 18 points on the total score. This is the Minimal Clinically Important Difference (MCID). A drop of 18 or more between the initial and follow-up DHI is real progress, not measurement noise.

4. What the DHI captures that clinical tests miss

A physiotherapist can perform Dix-Hallpike, head impulse tests, oculomotor screens, gait analysis and posturography — and still not know how much a patient's life has been derailed. Two patients can present with identical BPPV on positional testing yet one has a DHI of 22 and the other 78. Why? Because a truck driver whose income depends on head rotation experiences BPPV very differently from a retiree who can rest at home. The DHI captures that lived impact.

Emotional subscale scores also reveal patients at risk of anxiety and PPPD (persistent postural-perceptual dizziness), a chronic vestibular condition that requires a different treatment approach.

5. When we administer the DHI at Réhabital

We use the DHI at three key moments:

• Initial assessment. Establishes baseline severity and helps prioritize goals.
• 4–6 week reassessment. Verifies whether the program is working. If the DHI has not moved by at least 10–15 points, we revisit the diagnosis and adjust the plan.
• Discharge. Documents outcome, informs the family doctor, and creates a return-to-play threshold for future flare-ups.

We often email the DHI before the first visit so patients can fill it out at home, in a calm setting, without the fatigue of the appointment itself distorting answers.

6. The most common vestibular diagnoses behind high DHI scores

Benign Paroxysmal Positional Vertigo (BPPV). Dislodged inner-ear crystals; brief violent spinning triggered by position change. Treated in 1–3 sessions with canalith repositioning maneuvers (Epley, Semont, BBQ roll).

Vestibular neuritis and unilateral vestibular loss. Sudden severe vertigo lasting days, often after a viral illness. Central compensation is trained through gaze stabilization and habituation exercises over 6–12 weeks.

Ménière's disease. Episodic vertigo, fluctuating hearing loss and tinnitus. Rehabilitation focuses on between-attack function and fall prevention.

Vestibular migraine. Recurrent vertigo without hearing loss, often with headache history. Managed jointly with neurology; physio addresses provocation and reconditioning.

PPPD (persistent postural-perceptual dizziness). Daily non-rotatory dizziness worsened by upright posture and visual motion. Combined physio + CBT + often an SSRI.

Post-concussion vestibulo-ocular dysfunction. Common after mild traumatic brain injury; graded exposure and cervicogenic contributors screened.

7. The core exercises of vestibular rehabilitation

Vestibular rehab is not passive. The patient does most of the work through daily home exercises. The pillars are:

Gaze stabilization (VORx1, VORx2). Keeping the eyes fixed on a target while the head moves, forcing the vestibulo-ocular reflex to recalibrate.

Habituation exercises (Cawthorne-Cooksey and modern derivatives). Deliberate exposure to positions and movements that provoke mild dizziness, dosed to slightly challenge the system without overwhelming it.

Balance retraining. Standing on foam, tandem stance, single-leg, eyes-open then eyes-closed progressions. Rebuilds somatosensory and vestibular integration.

Gait training. Walking with head turns, walking on uneven ground, navigating grocery aisles or busy sidewalks — the environments patients avoid most.

Manual therapy for cervicogenic dizziness. When neck dysfunction contributes, cervical mobilization, muscle work and osteopathy referrals accelerate recovery.

8. What a full vestibular assessment at Réhabital includes

Our physiotherapist Colin Teghen Tamuton (OPPQ) runs a systematic exam:

• Detailed history — provocation pattern, duration, associated symptoms, red-flag screening.
• DHI questionnaire.
• Oculomotor screen — smooth pursuit, saccades, VOR, VOR cancellation, gaze-evoked nystagmus.
• Head impulse test.
• Positional testing (Dix-Hallpike, supine roll) — the gold standard for BPPV.
• Dynamic Visual Acuity test.
• Static and dynamic balance (Romberg, foam Romberg, tandem, Fukuda step, timed up-and-go).
• Cervical range of motion and manual palpation for cervicogenic contributors.

The full assessment takes 60 to 75 minutes. From it emerges a personalized rehabilitation plan and a home exercise program.

9. Home program: what daily practice looks like

Consistency wins. Most patients receive 3 to 5 exercises to perform twice daily for 5 to 10 minutes each. Total daily time is usually 15 to 25 minutes. Mild dizziness during exercises is expected and even necessary — it is the stimulus that triggers central compensation. Severe dizziness or nausea means the dose is too high and needs to be reduced.

We provide written and video guidance in French or English. Progress is reviewed weekly for the first month, then bi-weekly. Motivation is one of the strongest predictors of outcome; the DHI helps by making progress visible in numbers rather than feelings.

10. Red flags — when to go to the emergency room instead

Vestibular physiotherapy is safe and highly effective for the vast majority of dizziness causes, but not for all. Go to the emergency room immediately if dizziness is accompanied by:

• Sudden severe “worst ever” headache.
• Weakness or numbness on one side of the body.
• Slurred speech or trouble understanding speech.
• Double vision or new visual loss.
• Inability to stand or walk at all.
• Chest pain or shortness of breath.

These may indicate stroke, cardiac event or other emergencies that require imaging and hospital care, not physiotherapy.

11. Insurance and booking at Réhabital in Côte Saint-Luc

Réhabital accepts private insurance for physiotherapy; receipts are issued in your name for direct reimbursement. SAAQ (auto accident) claims may be covered — please call to confirm. Note that we do not accept CNESST (workplace injury) claims at this time.

Our clinic is located at the Cavendish Mall (D4-5800 boulevard Cavendish, Côte Saint-Luc) with free parking, a bilingual team, and evening/weekend availability. We welcome vestibular patients from Côte Saint-Luc, Hampstead, NDG, Snowdon, Montreal West, Westmount, Saint-Laurent and across the West End.

Book online 24/7 on Jane App, call 438-842-3550, or visit the physiotherapy page. Colin Teghen Tamuton (OPPQ) will conduct your full vestibular assessment, administer the DHI, and build the rehabilitation program that gets you back to normal life.