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Test Your Dizziness

Dizziness Handicap Questionnaire

Instructions

Print off the chart below or follow along on a piece of paper. Answer Yes, No, or Sometimes for each question.

Scoring

Give yourself points for each answer: No = 0, Sometimes = 2, Yes = 4.

Total Your Score

Possible scores range from 0 (suggesting no handicap) to 100, indicating significant perceived handicap. (Jacobson and Newman, 1999)


Yes

No

Sometimes

1. Does looking up increase your problem?

2. Because of your problem, do you feel frustrated?

3. Because of your problem, do you restrict your travel for business or recreation?
4. Does walking down the aisle of a supermarket increase your problem?
5. Because of your problem, do you have difficulty getting into or out of bed?
6. Does your problem significantly restrict your participation in social activities such as going out to dinner, going to the movies or going to parties?
7. Because of your problem, do you have difficulty reading?
8. Does performing more ambitious activities like sports, dancing, or household chores such as sweeping or putting away dishes increase your problem?
9. Because of your problem, are you afraid to leave your home without having someone accompany you?
10. Because of your problem, have you been embarrassed in front of others?
11. Do quick movements of your head increase your symptoms?
12. Because of your problem, do you avoid heights?
13. Does turning over in bed increase your symptoms?
14. Because of your problem, is it difficult for you to do strenuous housework or yard work?
15. Because of your problem, are you concerned people may think you're intoxicated?
16. Because of your problem, is it difficult for you to walk by yourself?
17. Does walking down a sidewalk increase your problem?
18. Because of your problem, is it difficult for you to concentrate?
19. Because of your problem, is it difficult for you to walk around your house in the dark?
20. Because of your problem, are you afraid to stay home alone?
21. Because of your problem, do you feel handicapped?
22. Has your problem placed stress on your relationships with family and friends?
23. Because of your problem, are you depressed?
24. Does your problem interfere with your job or household responsibilities?
25. Does bending over increase your problem?

Total from each column

TOTAL SCORE