Dizziness Handicap Inventory Questionnaire Research Articles

Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease

To evaluate the effectiveness of the vestibular rehabilitation (VR) exercises by means of an assessment before and after the application of the Brazilian version of the Dizziness Handicap Inventory (DHI) questionnaire. Twelve patients were studied, the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluation, and the application of the DHI before and after the VR. Clinically resting tremors and subjective postural instability were the motor complaints most frequently associated with complaints of vertigo in 12 cases (100%); in the vestibular exam, all the patients presented abnormalities, frequently from the uni and bilateral peripheral vestibular deficiency syndromes in 10 cases (83.3%); there was significant improvement in the physical, functional and emotional aspects of the DHI after the completion of the VR. The VR following the Cawthorne and Cooksey protocol were shown to be useful in managing subjective complaints of several aspects evaluated in this protocol.

Gamma Knife surgery of vestibular schwannomas: longitudinal changes in vestibular function and measurement of the Dizziness Handicap Inventory

Gamma Knife surgery (GKS) is one of the methods available to treat vestibular schwannomas (VSs), in addition to microsurgical resection; however, clear information regarding balance function outcomes and the impact of treatment on patients' quality of life over time remains an important clinical need. The purpose of this study was to assess the longitudinal balance outcomes and Dizziness Handicap Inventory (DHI) following GKS for VSs. This was a prospective clinical study of balance outcomes in all patients with VSs treated in the Acoustic Neuroma and Skull Base Surgery Program at a tertiary referral center by the senior author and the Gamma Knife team between June 2000 and May 2008. The main outcome measures included preoperative vestibular testing and postoperative caloric testing performed at 6-month intervals to determine vestibular function. The DHI questionnaires were administered retrospectively to assess the impact of GKS on self-perceived disability. Between June 2000 and May 2008, 55 sporadic VSs were treated. There was a >or= 60-month follow-up available in 27 of these patients, >or= 48 months in 32, >or= 36 months in 38, >or= 24 months in 43, >or= 12 months in 51, and >or= 6 months in 54 (1 patient was excluded from the analysis because the follow-up was < 6 months). Various patterns of changes in vestibular function were observed in either positive or negative directions. A significant difference in total DHI score was seen only in the elderly (> 65 years old) patients pre-GKS compared with post-GKS (t = 1.34, p = 0.05). Longitudinal changes in vestibular function occur over time, with the largest changes seen in the first 6 months after treatment. Potential for clinical intervention, such as vestibular rehabilitation therapy, exists during this interval; however, larger cohorts must be studied to determine the timing and efficacy of this intervention. The statistically significant improvement in the DHI score in the patient cohort > 65 years old treated with GKS suggests that this group may benefit from this option when considering the symptom of dizziness.

Falls among dizzy patients in primary healthcare: an intervention study with control group

The objective of this study is to investigate whether vestibular rehabilitation can improve balance, reduce self-perceived handicap because of dizziness and, if possible, reduce falls among dizzy patients in primary healthcare. The study also finds out which of the balance measures and measure of self-perceived handicap, if any, predicted the risk of falls. The design of this study is an intervention study with control group. Fifty-eight patients, 65 years and older, with multisensory dizziness were taken as participants. The intervention group trained vestibular rehabilitation twice a week for 9 weeks. All patients were assessed at baseline and after 3 months, with four different balance measures and the Dizziness Handicap Inventory. After 6, 9 and 12 months, a follow-up by telephone was performed and, at 12 months, the patients also filled out a Dizziness Handicap Inventory questionnaire. Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure (P=0.038 and 0.044). In total, 40 falls were reported, 31 were classified as intrinsic falls, 26 of them caused by vertigo and nine falls were classified as extrinsic. No difference was found between the two groups in proportions of patients who fell. Poor ability to stand in tandem stance doubled the risk for falls. Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness. Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment.

Reabilitação vestibular em idosos com Parkinson

OBJETIVO: verificar a efetividade dos exercícios de reabilitação vestibular (RV) por meio de avaliação pré e pós-aplicação do questionário Dizziness Handicap Inventory (DHI) - adaptação brasileira. MÉTODOS: avaliaram-se oito pacientes (três do sexo feminino e cinco do sexo masculino), na faixa etária de 48 a 71 anos, encaminhados da Associação Paranaense de Parkinson para o Laboratório de Otoneurologia da Universidade Tuiuti do Paraná. Os pacientes foram divididos em dois grupos e submetidos aos seguintes procedimentos: anamnese, avaliação otorrinolaringológica, avaliação vestibular por meio da vectoeletronistagmografia (VENG) e aplicação do questionário DHI - adaptação brasileira pré e pós RV utilizando-se os protocolos de Cawthorne e Cooksey (grupo A) e Herdman (grupo B). RESULTADOS: a) conforme as queixas otoneurológicas referidas na anamnese, observou-se a prevalência da tontura (100,0%), tremor (100,0%) e desvio de marcha (75,0&amp;); b) no exame vestibular, todos os pacientes (100,0%) apresentaram alteração, sendo a maior freqüência das síndromes vestibulares periféricas deficitárias (62,5%); c) houve melhora significativa dos aspectos funcional (p = 0,020470) e emocional (p = 0,013631) após a realização dos exercícios de RV utilizando-se o protocolo de Cawthorne e Cooksey e do aspecto emocional (p=0,007316) utilizando-se o protocolo de Herdman. CONCLUSÃO: comparando-se os dois protocolos utilizados, verificou-se uma melhora significativa dos pacientes do grupo A, submetidos ao protocolo de Cawthorne e Cooksey (p=0.0231).

Reabilitação vestibular em idosos com tontura

The aging of the population is a natural process and is manifested by a decline in the functions of several organs. Vestibular rehabilitation (VR) is a therapeutic process that seeks to promote a significant reduction in the symptoms of the labyrinth. To verify the benefits of VR exercises through the application of the Dizziness Handicap Inventory (DHI) questionnaire--Brazilian version--pre and post rehabilitation. Participants of this study were eight elderly patients with dizziness, ages between 63 and 82 years, three male and five female. The following procedures were carried out: medical history, otologic inspection, vestibular evaluation with vectoelectronystagmography (VENG), application of the DHI questionnaire and of the Cawthorne (1944) and Cooksey (1946) VR exercises. Regarding the auditory and vestibular complaints which were referred to in the medical history, the following was observed: presence of tinnitus, hearing loss, postural vertigo and of unbalance. In the evaluation of the vestibular function alterations were observed for all of the participants, mainly in the caloric test, with a prevalence of unilateral and bilateral hypofunction. In the vestibular exam the following was observed: three cases of unilateral peripheral vestibular deficit syndrome, three cases of bilateral peripheral vestibular deficit syndrome, one case of bilateral central vestibular deficit syndrome and one case of irritating bilateral central vestibular syndrome. There was a statistically significant improvement of the following aspects after VR: physical (p=0.00413), functional (p=0.00006) and emotional (p=0.03268). The VR protocol favored the improvement of life quality of the participants and was of assistance in the process of vestibular compensation.

末梢前庭疾患の残存前庭機能と動的前庭代償

Vestibular compensation, or neuronal plasticity in the central vestibular system, is quite an important process in patients with acute unilateral peripheral vestibular disease, allowing them to lead a comfortable daily life when medical treatments fail to cure the peripheral vestibular function. Is the residual unilateral vestibular input from damaged vestibular endo-organs a positive or negative factor for the development of dynamic vestibular compensation in the central nervous system? To elucidate the true mechanism of vestibular compensation, we examined the ENG findings and dizziness handicap inventory questionnaire in patients with vestibular neuronitis (VN), sudden deafness with vertigo (SDV), Meniere's disease (MD) and acoustic tumor (AT) during remission of the vertigo attacks. We obtained neuro-otological findings from caloric tests and head shaking after nystagmus using ENG and information on motion-evoked dizziness in daily life using the questionnaire. There were no significant differences in the sex, age or canal paresis % (CP%) among the four groups. The results of the present study showed that dynamic vestibular compensation processes developed progressively in the order of patients with SDV, VN, MD and AT (Kruskal-Wallis : p < 0.05). This finding suggests that processes of dynamic vestibular compensation could be accelerated in patients with fixed vestibular lesions caused by SDV and VN more than in those with fluctuating vestibular functions caused by MD and AT. In patients with fixed vestibular lesions caused by SDV and VN, patients with lower CP% showed dynamic vestibular compensation (i.e. disappearance of head shaking after nystagmus (chi-square: p < 0.05) and motion-evoked dizziness (Mann-Whitney: p < 0.0005)) more rapidly than those with higher CP%. In patients with fluctuating vestibular functions caused by MD and AT, patients with lower CP% did not always develop dynamic vestibular compensation more smoothly than those with higher CP%.

Cochlear Implant and Vestibular Function

To document incidences of vestibular dysfunction after cochlear implantation and investigate why it occurs. This work was also motivated by a desire to provide the basis for better preoperative counseling and postoperative vestibular therapy to cochlear implant patients. Melbourne Cochlear Implant Clinic at a tertiary referral hospital. Prospective observational study. One hundred forty-six adult implant recipients, mean age, 60 years (range, 20-90 yr). Postoperative vestibular disturbance was defined as symptoms lasting for 1 week or longer after surgery. The differences in preoperative and postoperative vestibular function were measured from subjective assessments (Dizziness Handicap Inventory and Activity Balance Confidence questionnaires) and objective assessments (bithermal caloric tests). The position of the postoperative electrode was classified as "loose", "regular", or "tight" fitting. Thirty-two percent of patients reported vestibular disturbance and had poorer Dizziness Handicap Inventory, Activity Balance Confidence, and caloric results in the implanted ear after surgery. Patient age, cause, and preoperative caloric result did not predict postoperative vestibular symptoms. Recipients aged 70 years or older had significantly poorer caloric results on the implanted side after surgery that was not related to the intracochlear electrode position or surgical team. One-third of recipients can expect to experience a significant vestibular disturbance after surgery, regardless of age, cause, or preoperative caloric result. "Older" ears seem more prone to permanent injury after cochlear implantation.

Effects of Vestibulo-ocular Reflex Exercises on Vestibular Compensation after Vestibular Schwannoma Surgery

To assess vestibular function in a large group of vestibular schwannoma patients so that we could determine whether simple vestibular exercises speed vestibular dysfunction recovery after tumor removal surgery. A prospective investigation of the vestibular dysfunction experienced by patients in the first 12 weeks after surgery. Vestibular investigation unit at a tertiary referral institution. Sixty-five patients with identified vestibular schwannoma referred for preoperative vestibular investigations. Thirty-two men and 33 women, with a mean age 51 years (range, 24-77 yr). There were 27 control patients, 30 exercise patients, and 8 patients that had balance physiotherapy. Exercise patients began simple vestibulo-ocular reflex gaze stabilization exercises 3 days after surgery. Postoperative vestibular function testing was performed at 2 to 3, 6 to 7, and 10 to 12 weeks after surgery. Objective measurements of vestibular compensation status were as follows: spontaneous nystagmus and sinusoidal harmonic acceleration asymmetry and gain values. Dizziness Handicap Inventory questionnaires were used to assess subjective perceptions. The main findings were reduced dispersion in vestibulo-ocular reflex asymmetry at 2 to 3 weeks, reduced mean in asymmetry at 6 to 7 weeks, less dizziness/imbalance according to the Dizziness Handicap Inventory questionnaire, and that preoperative caloric tests did not predict postoperative severity of vestibular systems. This large study provided unique evidence that a program of simple vestibular exercises and education can speed the rate of compensation after vestibular schwannoma surgery.

Factor Analysis and Correlation Between Dizziness Handicap Inventory and Dizziness Characteristics and Impact on Quality of Life Scales

In order to assess the different dimensions of disability and handicap analyzed in the Dizziness Handicap Inventory (DHI) and Dizziness Characteristics and Impact on Quality of Life (UCLA-DQ) questionnaires a factor analysis study was done. The instruments used were the corresponding transculturally adapted versions of the originals into Spanish. The study included 337 patients with dizziness, independent of location and etiology, who were able to respond to all the items in the questionnaires given before vestibular testing. Factor analysis was used to determine the structure of both scales; a principal components analysis with orthogonal rotation (Varimax) was conducted on data collected from the patients. A three-factor solution was obtained in the DHI and a two-factor solution for the UCLA-DQ. The factors obtained from the DHI were related to vestibular handicap, vestibular disability and visuo-vestibular disability; the factors from the UCLA-DQ were related to frequency and severity of dizziness. There was no coincidence between the items in each of the factor obtained in the DHI questionnaire and the items in the subscales provided in the original version. The main relation between factors was found between vestibular handicap and frequency. The DHI and UCLA-DQ questionnaires are multidimensional questionnaires for the assessment of the impact of dizziness and provide a model for vestibular disability and handicap.

Effects of T'ai Chi on balance.

To determine if the practice of T'ai Chi significantly improves balance. Twenty-two persons with mild balance disorders were studied. Five measures of balance were obtained, including 3 objective measures (moving platform posturography, Romberg testing, and reach testing) and 2 disability questionnaires (Dizziness Handicap Inventory and a modified Medical Outcomes Study general health survey). To be included, patients were required to be able to stand in the eyes-closed regular Romberg position for 30 seconds. The subjects underwent 8 weeks of T'ai Chi training and practice and then were retested. Highly significant improvements were found on both the posturography test and the Dizziness Handicap Inventory questionnaire scores (P<.001 and P=.004, respectively). Trends toward improvement were also noted in Romberg test results and the Medical Outcomes Study survey (P=.03 for both). Reach was not improved. These findings suggest that T'ai Chi training improves balance.

Measurement of health status in patients with vertigo

In order to assess how much disability is caused by vertigo, health status scores of patients referred with dizziness or vertigo were compared with local population normative data and with the severity of illness, measured by a disease-specific questionnaire. The questionnaires were administered by post to patients awaiting an ENT out-patient appointment. There was a strong correlation (P = 0.001) between the eight dimensions of the SF-36 (Mos 36 item short-form health survey) and disease severity, measured by the Dizziness Handicap Inventory questionnaire. Compared with the general population, vertigo sufferers had significant role limitation due to physical problems and social functioning (men) and physical problems and vitality (women). General health status is significantly affected by both the presence and severity of vertigo and the SF-36 may prove useful in assessing outcomes.